Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Expectations Pub Date : 2024-11-12 DOI:10.1111/hex.70100

Emma Kinley, Hilary Pinnock, Liz Steed, Kirstie McClatchey

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Abstract

Background

Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP²ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management.

Objective

To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery.

Design, Setting and Participants

We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP²ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs).

Results

HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP²ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM.

Conclusions

HCPs in UK primary care spent half the time in both face-to-face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP²ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group.

Patient and Public Contribution

Asthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant-facing documents, and discussing implications of study findings.

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在初级保健哮喘审查中提供支持性自我管理：IMP2ART 计划的启示。

背景：哮喘的支持性自我管理（SSM）可降低哮喘发作的风险，改善哮喘控制和生活质量。自我管理的最佳方式包括以患者为中心的沟通和行为改变支持，但在常规初级保健中的应用程度尚不清楚。该项目嵌套在 "IMP2ART"（IMP Implementing IMProved Asthma self-management as RouTine）计划中；该计划是一项英国范围内的试验，旨在评估一种实施策略（包括医疗保健专业人员（HCP）行为改变策略培训和以患者为中心的护理），以改善对哮喘自我管理的支持：通过评估自我管理策略所花费的时间、以患者为中心的护理和行为改变讨论的实施方式和程度，了解医护人员如何在英国临床实践中实施自我管理，并探讨审查模式或实施支持等因素是否会影响实施：我们对参与 IMP2ART 试验的全科诊所样本（实施样本 4 个；对照样本 6 个）中 12 名保健医生进行常规面对面和电话哮喘复查（样本数 = 64）的录像进行了观察研究。分析方法包括ALFA工具包多通道视频观察（对所执行的任务进行编码和量化）；以患者为中心的观察表；行为改变咨询指数（评估以患者为中心的情况和保健医生使用的行为改变咨询）：在常规哮喘复查中，医疗保健人员大多会花时间讨论：个人哮喘状况和管理（平均占就诊时间的 27.8%）；合作审查和完成个性化哮喘行动计划（6.3%）以及实际自我管理活动培训（5.4%）。以患者为中心的护理服务和行为讨论领域包括：建立和维护人际关系、讨论哮喘行动计划和药物调节。IMP2ART实施小组中的专业人员提供了更多的自我管理策略。对面对面咨询和远程咨询进行比较后发现，医疗保健人员在提供 SSM 方面没有明显差异：结论：英国初级医疗保健机构的专业人员在面对面和远程哮喘复查中都花费了一半的时间来实施 SSM，这表明两种实施方式都是可以接受的。与对照组相比，在IMP2ART实施组实践中进行的复查显示了更多的行为改变和合作性SSM策略：英国哮喘应用研究中心（AUKCAR）的患者和公众参与计划成员全程参与，包括项目构思、对面向参与者的文件提供反馈以及讨论研究结果的影响。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.