Do we need asthma clinics in primary care? Patients' views and perspectives

Abstract

Asthma is a common chronic condition which places a considerable burden on patients and NHS resources. The relatively high prevalence, together with its innate variability, makes the provision of care by primary teams an essential and recognized part of overall management which is now generally undertaken by enthusiastic asthma-trained nurses. Despite 10 years of such organized care, there is little evidence of its effectiveness, with few data available on who attends and for what reason. We do not know the views of those for whom the clinics were intended, namely the patients. Here we report the results from two qualitative studies, one using in-depth interviews with individual patients and the other using focus groups on a range of different patients. The first study involved 30 adult patients whose pattern of compliance with inhaled medication allowed categorization of individuals into ‘compliers’ and ‘non-compliers’. The results of this study allowed a typology to be developed which categorized patients into ‘distancers/deniers’, ‘accepters’ and ‘pragmatists’. The focus group involved 70 patients (35 patients on two occasions) from a mixture of practices, and varying age and socio-economic groups. Both studies yielded remarkably similar results, and they show that patients, for a variety of reasons, do not regard asthma clinics as being of relevance to them and generally do not attend. Using the typology that was developed, we present reasons for their non-attendance based on the recurring rich quotes from patients. It is clear from these results that if practices run endless clinics, patients will not attend for the reasons given. Further work involving both quantitative and qualitative techniques is needed to explore who attends asthma clinics and why. Patients' views should now be integrated into future service planning, and the current educational role of the asthma clinic should be replaced by one which more closely reflects patients' needs and expectations.