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Review management for children with asthma in primary care: a qualitative case study
Geraldine Lyte1, Linda Milnes, Peggy Keating
1School og Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, UK. geraldine.lyte@man.ac.uk
Insights
Review management of childhood asthma in primary care needs clearer roles and a family-centered approach. Families reported unmet needs, while professionals lacked clarity in providing this care.
Area of Science:
- Pediatric Respiratory Medicine
- Primary Healthcare Services
- Qualitative Research Methods
Background:
- Childhood asthma review management is crucial for reducing morbidity but is often fragmented in primary care.
- The effectiveness of primary care asthma clinics and stakeholder perceptions remain poorly understood.
- Understanding the needs of children, families, and healthcare professionals is vital for service improvement.
Purpose of the Study:
- To examine the organization and stakeholder perceptions of childhood asthma review management in UK primary care.
- To identify the needs of children and families regarding asthma care.
- To understand professional perspectives on delivering family-centered asthma care.
Main Methods:
- A qualitative case study design was employed.
- Interviews were conducted with 18 children, 16 parents, 14 practice nurses, and 14 general practitioners across 14 general practices.
- Review appointments were observed, and asthma-related documentation was analyzed.
Main Results:
- Significant diversity exists in service delivery, with practice nurses viewed as primary managers.
- Issues identified include unclear responsibilities, fragmented interdisciplinary communication, and neglected family needs.
- Professionals expressed uncertainty in providing family-centered care.
Conclusions:
- Formalizing responsibilities for childhood asthma review consultations is necessary, advocating for a proactive, family-centered approach.
- The role of practice nurses requires enhanced professional education for effective family-centered care delivery.
- Unstructured care delivery, unmet family needs, and professional uncertainties highlight areas for improvement in primary care asthma management.
Aims Of The Study:
To present an overview of review management of childhood asthma in one UK primary care trust with respect to organization and perceptions of key stakeholders and children's and families' needs.
Background:
Review management of childhood asthma in primary care is important in addressing the continuing high levels of morbidity. However, the delivery of this service appears to be fragmented, so it is not known how well primary care asthma clinics function. Children's, parents' and professionals' perceptions of such clinics and the roles they play within them are also poorly understood.
Research Design:
A qualitative case study design was used in the study. This is a form of enquiry that investigates contemporary issues within their real life contexts, using particular situations within the case to describe important phenomena.
Methods:
Eighteen children, 16 parents, 14 practice purses and 14 general practitioners from 14 general practices in one primary care trust were interviewed. Review appointments were observed and asthma-related documentation examined.
Findings:
Key findings point to diversity in the service and that key stakeholders' view practice nurses as primarily responsible for the review management. However, there are issues related to their levels of responsibility, other health professionals' roles and interdisciplinary communication. Finally, families felt some of their needs were neglected and professionals reported uncertainties in providing family-centred care.
Conclusions:
This case study indicates that responsibility for review consultations in childhood asthma needs to be formalized, including a more proactive and family-centred approach. There are implications for the practice nurse role regarding professional education and preparation for family-centred care.
Relevance To Clinical Practice:
This paper shows that unstructured, diverse care delivery persists in primary care; children and their families identify both strengths and unmet needs in review management visits; and professionals have uncertainties about providing effective child and family-centred care.
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