Personal asthma action plans (PAAPs) have been recommended for over two decades in light of evidence suggesting that, when properly used, these self-management practices have important and beneficial effects in clinical outcomes, such as reducing asthma exacerbations, hospitalizations, and increased treatment adherence. But despite the clear benefits, these guidelines have not been implemented to their full potential. In a new study, researchers set out to understand, from the perspective of health care professionals and patients, why PAAP implementation has been so poor. The research paper, entitled “The ‘vicious cycle’ of personalised asthma action plan implementation in primary care: a qualitative study of patients and health professionals’ views,” was published in BMC Family Practice.
The study involved 29 participants: 11 asthma patients from five different general practices and 18 health care professionals (10 practice nurses, seven general practitioners, one hospital respiratory nurse). All participants were interviewed and the researchers summarized the results in three major conclusions: patients undervalue and underuse PAAPs, healthcare professionals undervalue and under-prescribe PAAPs, and several barriers were identified that reduced the value of PAAPs in primary health care.
Researchers concluded that patients do not realize the value of PAAPs. Six of the interview patients had been prescribed PAAPs, but none of them reported that they were indeed using them. This was justified by several reasons, including patient dissatisfaction with the plan’s development and the plan’s poor relation to asthma symptoms or current treatment, and only one patient reported that the plan had been reviewed by qualified staff. Overall, patients did not see the personal need for PAAPs, but agreed that they could be useful for at-risk people, such as children or recently diagnosed patients.
From the health care professional perspective, the interviews revealed that there was no unanimous support of PAAPs. Fifteen health professionals had prescribed PAAPs at least once, with eight reporting have done revisions to the plans, although not consistently for every patient. This was justified by the lack of interest presented by patients in using or even discussing their PAAPs in asthma consultations.
Researchers categorized the barriers to the implementation of PAAPs reported by patients and health care professionals into two groups: individual and organizational. Individual barriers include lack of patient awareness, patient dissatisfaction with PAAPs, and lack of reinforcement by the professionals. Organizational barriers led to difficulties in obtaining the PAAP templates, difficulties accessing patients’ records during consultations, and loss of information regarding changes in patients’ forms.
Overall, researchers conclude that both patients’ and professionals’ attitude and lack of information hinder the process of implementation of this beneficial protocol. Furthermore, this vicious cycle is complicated by practical barriers in everyday health care management. The researchers believe that solutions to the problem include raising awareness of PAAPs’ relevance to patient well-being and better organizational processes in health practices.