Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

Abstract

BackgroundAcute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians’ adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence.MethodsWe conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data.ResultsSeventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians’ and patients’ expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma.ConclusionsThis qualitative study provides insight into paramedics’ perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma.

The Need for More Prehospital Research on Language Barriers: A Narrative Review

“… 21 Focus groups of paramedics in the United Kingdom also identified language discordance as a barrier to adherence to asthma treatment guidelines. 30 Collectively, these studies provide indirect suggestions that EMS care differs when confronted with language barriers, but do not allow for more nuanced analysis or conclusions.…”

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

“…To have correct patient management and agreement on a right and timely decision, especially in critical situations, EMTs' teamwork must be done based on mutual trust and interaction. [ 31 32 ]…”

Produção Do Cuidado E a Rede De Atenção a Pessoa Com Doença Respiratória Crônica: Um Estudo De Revisão

“…Ou seja, vai além das questões que envolvem os estabelecimentos, ou apenas o acesso, mais, a qualidade dos trabalhadores na rede de atenção também deve ser um ponto a ser interrogado 22,23 .…”

“…No Reino Unido, um estudo realizado destacou a necessidade de integração dos serviços para tornar mais eficaz o manejo da pessoa com Asma e RA, com ações de educação permanente para construir habilidades mais sólidas no quesito comunicação entre os usuários e trabalhadores 22 .…”

“…Destaca-se ainda que, o acesso aos serviços de saúde em momentos de crise pode facilitar o processo de reabilitação, o que deixa o usuário mais tranquilo, no entanto, quando essa barreira surge, a tensão existente pode inclusive piorar o quadro, aumentando assim a sua gravidade, há uma real necessidade de disponibilização de profissionais capazes de agir e de centros de reabilitação e tratamento específicos para estas pessoas 22,[33][34][35] .…”