Diagnosis Of Asthma In Primary Care Research Articles

Clinician views on how clinical decision support systems can help diagnose asthma in primary care: a qualitative study

Objective Asthma can be difficult to diagnose in primary care. Clinical decision support systems (CDSS) can assist clinicians when making diagnostic decisions, but the perspectives of intended users need to be incorporated into the software if the CDSS is to be clinically useful. Therefore, we aimed to understand health professional views on the value of an asthma diagnosis CDSS and the barriers and facilitators for use in UK primary care. Methods We recruited doctors and nurses working in UK primary care who had experience of assessing respiratory symptoms and diagnosing asthma. Qualitative interviews were used to explore clinicians’ experiences of making a diagnosis of asthma and understand views on a CDSS to support asthma diagnosis. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. Results 16 clinicians (nine doctors, seven nurses) including 13 participants with over 10 years experience, contributed interviews. Participants saw the potential for a CDSS to support asthma diagnosis in primary care by structuring consultations, identifying relevant information from health records, and having visuals to communicate findings to patients. Being evidence based, regularly updated, integrated with software, quick and easy to use were considered important for a CDSS to be successfully implemented. Experienced clinicians were unsure a CDSS would help their routine practice, particularly in straightforward diagnostic scenarios, but thought a CDSS would be useful for trainees or less experienced colleagues. Conclusions To be adopted into clinical practice, clinicians were clear that a CDSS must be validated, integrated with existing software, and quick and easy to use.

Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia.

ObjectiveUse of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage.MethodsData used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA.ResultsA weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector.ConclusionOral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.

Asthma Diagnosis in Spain: Survey of Opinions, Attitudes and Knowledge among Primary Care Physicians

Background: Asthma is frequently misdiagnosed. Peak expiratory flow (PEF) measurement is easy and very useful for asthma diagnosis in primary care. Objectives: The DIANA project aimed to assess the impact of a course on PEF measurement among primary care physicians in Spain. Methods: A 7-item questionnaire was sent to selected primary care physicians (Phase A). Respondents were then invited to take a web-based course on PEF in asthma diagnosis. Finally, the questionnaire was again sent to all physicians (Phase B). Questionnaires also asked for demographical data such as age, sex, speciality, route of access to speciality, and geographical area. A comparative statistical analysis was performed on the results of both questionnaires. An extended analysis was performed later. Answers were analysed by percentages and using McNemar’s test. The planned duration of the project was one year. Results: No statistically significant differences in percentages between the two phases were found for Items 1 (related to asthma diagnosis) and 4 (related to availability and use of PEF meter). However, for Item 2 (related to diagnosis of occupational asthma) differences were significant (p<0.05), with an odds ratio (OR) of 1.50 for those participating in Phase B. Differences were also significant (p<0.05) for those who took the course, with an OR of 1.37. For Item 3 (related to the usefulness of measuring daily variability of PEF), there were also significant differences (p<0.05) between the two phases, with an OR of 1.39. There were also significant differences (p<0.05) for those who took the course, with an OR of 1.53. Conclusions: The first four results of the survey showed that educational intervention may improve knowledge of the usefulness of PEF in asthma diagnosis among primary care physicians. However, the high percentages of correct answers among those who did not take the course merit further investigation.