Asthma patients’ perception on their care pathway: a qualitative study

Abstract

Because of insufficient asthma control in many patients, the collaboration between stakeholders is regarded as a promising strategy to improve asthma outcomes. This study explored the perceptions of French adult asthma patients on their care pathway. We conducted a qualitative study based on the interviews of 30 asthma patients aged 18–40 years, recruited in French primary care. We performed a thematic analysis of the data collected, using the NVivo software. According to the patients, the stakeholders involved in asthma management included those visible to healthcare professionals (patient, general practitioner, specialist(s), pharmacist, physiotherapist, family and friends) and those concealed by the patients (complementary and alternative practitioners); other stakeholders, such as nurses and occupational physicians, were not involved. Asthma management at diagnosis and follow-up phases proved to be unstructured, and were associated with poor patient education. This was supported by patients’ ambivalence (in relation to illness and treatments), poor communication between patients and healthcare professionals (lack of listening and use of inappropriate vocabulary by physicians, underreporting of alternative medicine use by patients) and weak cooperation between professionals (limited to interaction between the general practitioner and the specialist, either pulmonologist or allergist). Asthma management would probably benefit from a more coordinated care pathway at each phase of the disease that is consistent with the expectations and goals of the patients. It should be based on improved organization (involvement of other healthcare professionals and the patient as partners) and processes (regular follow-up, specific tools such as peak flow meter or action plan).

<p>What Means A Quality Professional–Patient Relationship From The Asthmatic Patients’ Perspective? A Narrative Review Of Their Needs And Expectations</p>

“…Because more multidisciplinary communication was expected, this one can be greatly enhanced by the creation of such a care pathway which would accompany the patient since the diagnose announcement and throughout the chronic follow-up. We join therefore the conclusions of a very recent study 47. An ANP and a physiotherapist could certainly join the team to bring their expertise.…”

Perspectives on decisions for treatment and care in severe asthma

“…18 However, the misalignment of perspectives on asthma control is not only a result of physician underestimation of asthma severity; worldwide, people with asthma lack understanding on how well their condition is controlled and do not recognise that change in symptoms is an indicator of poor control, emphasising a disconnect between the guidelines and individuals’ perceptions of their own asthma. 8 …”

“…As the level of asthma control correlates with quality of life (QoL), 4 communication has to improve between people with asthma and their health care providers, even at routine visits, to ensure appropriate treatment plans are created. 8 , 17 Strategies to assess and improve patient-physician communications have been explored to reduce the asthma burden for individuals; 5 , 8 , 19 in Latin America, technologies such as email have been suggested as a method of improving the frequency and speed of communication between the physician and patient. 19 However, to ensure improvement in communication globally, it is essential that primary care physicians (PCPs) have training to ensure that they refer individuals with severe asthma to pulmonologists in secondary care, for example, 8 and that they communicate with patients effectively to ensure understanding of their treatment pathway.…”

“…The views of caregivers and others in the support network (for instance those who provide childcare during exacerbations or those who collect medication when the individual with asthma cannot do so) would help shape the delivery of health care services through initiatives such as multidisciplinary teams. 8 , 21 It is also imperative for people with asthma and their support network to communicate effectively with each other, as criticism has the potential to negatively impact on an individual's asthma. 21 …”

“… 7 However, this is not always the case, which creates an unsatisfactory patient experience, resulting in poor treatment outcomes. 8 …”