<p>Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK</p>

Abstract

Background: Guidelines recommend that asthma treatment should be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed. Objective: To explore views, experiences, barriers and ideas, of doctors, nurses and pharmacists working in primary care, related to step down of asthma medication. Methods: Primary care practitioners from across the UK participated in a survey and/or semi-structured interview. Questions explored four main areas: how asthma medication is reviewed, views on asthma guidelines, perceived barriers faced by healthcare workers and facilitators of stepping down. Qualitative content analysis enabled data coding of interview transcripts to identify major themes. Results: A total of 274 participants responded to the survey, 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doc-tors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were (i) lack of awareness of the need to step down, (ii) inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down, (iii) self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and (iv) feasibility of step down, driven by a lack of systematic acceptance of stepping down and time. Strategies proposed to reduce overtreatment included education and training, improved gathering of evidence and guidance, and integrating step down into routine asthma care. Conclusion: Failure to implement this guideline recommendation into everyday asthma management is influenced by several contributing factors. Future directions should include addressing evidence gaps, implementing clear and practical guidance, integration of stepdown assessment into the asthma review, and education of professionals and patients.

A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis

“…, 21 , 22. , 24 , 26 , 31 Three studies were done in UK, 17 , 27 , 30 two studies in Canada, 25 , 28 one study in Indonesia, 19 one study in Denmark 23 and one study in USA. 29 …”

“…Studies mostly used semi-structured interviews as a method for data collection ( n = 11), 8 , 16 , 17. , 18 , 20 , 21 , 23 , 26 , 28 , 30 , 31 while five studies used focus group 19 , 24 , 25 , 27 , 29 and one study used both interviews and focus groups.…”

“…Twelve studies involved different healthcare professionals or asthmatic patients with pharmacists, 15. , 16 , 17. , 18 , 21 , 24.…”

“…whereas five studies were conducted in primary care settings. 8 , 17 , 21 , 24 , 26 Two studies were conducted in a variety of settings, including tertiary, primary and community. 15 , 19 One study included one hospital only 25 and another study was done in a small health centre.…”

“… -First study reported on the views of GPs, pharmacists and patients of such an intervention. -Low response rate -Recruitment bias -A sample of respondents from northern and southern Tasmania only (not generalisable) 7 17 UK Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK Primary care Qualitative methodology using a questionnaire and semi-structured interviews. 12 doctors, 9 nurses and 8 pharmacists working in primary care were interviewed.…”