Abstract
BackgroundThe COVID-19 pandemic has led to the rapid and reactive deployment of remote consulting in UK general practice. The delivery of acute and chronic asthma care has been affected. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context–intervention interactions affect implementation.AimTo explore the implementation of remote asthma consulting in UK general practice in response to the COVID-19 pandemic.Design & settingMixed-methods evaluation, which was informed by eNPT, in general practice in Northern Ireland.MethodData were collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews, and multidisciplinary focus groups. Analysis was informed by eNPT.ResultsTen themes were identified to describe and explain the contribution of general practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to in-person review. Having a practice champion to drive implementation forward, and engage other practice staff, was important. Patient, staff, and healthcare system-contextual factors influencing implementation were identified including access to, understanding of, and willingness to use the technology required for remote consulting.ConclusionThe experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it. Work is required at practice and healthcare system levels to realise this potential, and ensure implementation does not exacerbate existing healthcare inequalities.
Highlights
Provision of asthma care has been dramatically affected by the COVID-19 pandemic
We identified ten themes to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting
The experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it
Summary
Provision of asthma care has been dramatically affected by the COVID-19 pandemic. In March 2020, to reduce viral spread, General Practices in the UK were advised to consult remotely with patients where possible. Patients deemed at highest risk from COVID-19 were advised to ‘shield’ themselves, including patients with Severe Asthma [1]. Interim guidance advised that, where possible, following risk assessment and determination of severity, mild and low risk moderate asthma exacerbations could be managed remotely during the pandemic period [2,3,4,5]. The Quality and Outcomes Framework (QOF), the key method of remuneration for chronic asthma care in General Practice, was paused at the start of the pandemic to shift resources and focus to acute care. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context-intervention interactions affect implementation
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