Explaining the amount and consistency of medical care and self-management support in asthma: a survey of primary care providers in France and the United Kingdom

Publication date: Available online 9 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Marijn de Bruin, Alexandra L. Dima, Nathalie Texier, Eric van Ganse
BackgroundThe quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.ObjectivesTo examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.MethodsAn online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.ResultsOn average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support –but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.ConclusionsUsing carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.