Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi

Area of Science:

• Respiratory Medicine
• Primary Care
• Health Services Research

Background:

• Difficult-to-manage asthma patients require specialized assessment and care.
• The International Primary Care Respiratory Group (IPCRG) framework distinguishes difficult-to-manage from severe asthma.
• Local adaptation of the IPCRG approach is necessary for effective implementation in the Netherlands.

Purpose of the Study:

• To develop a locally adapted program for managing difficult-to-manage asthma in the Dutch primary care setting.
• To identify and prioritize key components for a difficult-to-manage asthma program through stakeholder consensus.

Main Methods:

• A modified three-round electronic Delphi (e-Delphi) approach was employed.
• Involved diverse stakeholders: general practitioners, pulmonologists, practice nurses, pulmonary nurses, and asthma patients.
• Iterative rounds of item generation, rating (seven-point Likert scale), categorization, and ranking were conducted.

Main Results:

• Initial input generated 67 potential program items.
• 46 items were selected as relevant based on stakeholder ratings.
• Items were categorized and ranked, leading to the 'A-I of difficult-to-manage asthma' acronym.

Conclusions:

• The developed 'A-I of difficult-to-manage asthma' program is tailored for the Dutch context.
• The program's acronym aims to integrate with existing Dutch asthma and COPD educational materials.
• This approach can potentially improve the management of difficult-to-manage asthma and can be adapted globally.