Setting the standard for routine asthma consultations: a discussion of the aims, process and outcomes of reviewing people with asthma in primary care

Abstract

Globally, asthma morbidity remains unacceptably high. If outcomes are to be improved, it is crucial that routine review consultations in primary care are performed to a high standard. Key components of a review include: * Assessment of control using specific morbidity questions to elucidate the presence of symptoms, in conjunction with the frequency of use of short-acting bronchodilators and any recent history of acute attacks * After consideration of the diagnosis, and an assessment of compliance, inhaler technique, smoking status, triggers, and rhinitis, identification of poor control should result in a step-up of treatment in accordance with evidence-based guideline recommendations * Discussion should address understanding of the condition, patient-centred management goals and attitudes to regular treatment, and should include personalised self-management education Regular review of people with asthma coupled with provision of self-management education improves outcomes. Underpinned by a theoretical framework integrating professional reviews and patient self-care we discuss the practical barriers to implementing guided selfmanagement in routine clinical practice.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…257 A RCT 226 and a randomised implementation study, 228 evaluated interventions designed to increase the proportion of people with asthma who had a routine review, a core component of which is the provision of self-management education. 280 Both succeeded in their aim of facilitating asthma reviews, Kemple The whole-systems approach…”

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

“…A recent review of asthma education determined that if asthma education is to result in long-term health outcomes, an approach to asthma education which is delivered routinely and keeps the shared patient and health care professional goals in mind, is required [66]. This is supported by research identifying the importance of communication in enhancing asthma patient's experiences, fostering engagement, and encouraging the patient to follow through their treatment plans [40,60,67,68]. Further to that, a literacy-sensitive, culturally and linguistically appropriate approach should also be incorporated [69][70][71][72][73].…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…[38][39][40][41] Guidelines highlight the importance of developing a partnership between the doctor and the patient [12][13][14]36 so that regular professional review and monitoring of people with asthma is combined with appropriate treatment recommendations and selfmanagement education to enable patients to achieve treatment goals. 42 The dual concepts of asthma severity and asthma control have been widely discussed. [43][44][45] Recent guidelines have changed their emphasis from classification of severity to the goal of achieving asthma control, 12 prioritising the objective assessment of control.…”