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

Deborah Shaw,Aloysius Niroshan Siriwardena

doi:10.1186/1471-227x-14-18

Deborah Shaw, Aloysius Niroshan Siriwardena

Open Access

https://doi.org/10.1186/1471-227x-14-18

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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.

Highlights

Acute asthma is a common reason for patients to seek care from ambulance services
* Correspondence: debbie.shaw@emas.nhs.uk 1Clinical Audit and Research Department, East Midlands Ambulance Service NHS Trust, East Division Headquarters, Cross O’Cliff Court, Lincoln LN4 2HL, England Full list of author information is available at the end of the article, and emergency care technicians or assistants provide important assessment and potentially life-saving treatment at the patient’s home and, if necessary, provide transport to hospital for further treatment according to national guidelines
During initial analysis 60 codes were identified which we grouped into the following themes: (1) guidelines should be 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; and (5) there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma

Summary

Introduction

Acute asthma is a common reason for patients to seek care from ambulance services. 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. Between 26% and 59% of patients with acute asthma requiring hospitalisation are attended by ambulance services [3,4,5]. Ambulance services in the UK use national guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). At the time of the study JRCALC UK Ambulance Service Clinical Practice Guidelines 2006, covering general, condition specific, and drug guidelines for asthma were in use (Table 1) [6]. The JRCALC and related British Thoracic Society [6,7] guidelines emphasise

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