Lingner H, Burger B, Kardos P, Criée C P, Worth H, Hummers-Pradier E
Centre for Public Health and Healthcare, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.
Klinik für Psychosomatische Medizin, DIAKOVERE gGmbH - Henriettenstiftung, Hannover, Germany.
BMC Pulm Med. 2017 Jan 11;17(1):13. doi: 10.1186/s12890-016-0346-6.
Treatment of asthma does not always comply with asthma guidelines (AG). This may be rooted in direct or indirect resistance on the doctors' and/or patients' side or be caused by the healthcare system. To assess whether patients' concepts and attitudes are really an implementation barrier for AG, we analysed the patients' perspective of a "good asthma therapy" and contrasted their wishes with current recommendations.
Using a qualitative exploratory design, topic centred focus group (FG) discussions were performed until theoretical saturation was reached. Inclusion criteria were an asthma diagnosis and age above 18. FG sessions were recorded audio-visually and analysed via a mapping technique and content analysis performed according to Mayring (supported by MAXQDA®). Participants' speech times and the proportion of time devoted to different themes were calculated using the Videograph System® and related to the content analysis.
Thirteen men and 24 women aged between 20 and 77 from rural and urban areas attended five FG. Some patients had been recently diagnosed with asthma, others years previously or in childhood. The following topics were addressed: (a) concern about or rejection of therapy components, particularly corticosteroids, which sometimes resulted in autonomous uncommunicated medication changes, (b) lack of time or money for optimal treatment, (c) insufficient involvement in therapy choices and (d) a desire for greater empowerment, (e) suboptimal communication between healthcare professionals and (f) difficulties with recommendations conflicting with daily life. Primarily, (g) participants wanted more time with doctors to discuss difficulties and (h) all aspects of living with an impairing condition.
We identified some important patient driven barriers to implementing AG recommendations. In order to advance AG implementation and improve asthma treatment, the patients' perspective needs to be considered before drafting new versions of AG. These issues should be addressed at the planning stage.
DRKS00000562 (German Clinical Trials Registry).
哮喘治疗并不总是遵循哮喘指南（AG）。这可能源于医生和/或患者方面的直接或间接抵制，或者是由医疗保健系统造成的。为了评估患者的观念和态度是否真的是AG实施的障碍，我们分析了患者对“良好哮喘治疗”的看法，并将他们的愿望与当前建议进行了对比。
采用定性探索性设计，进行以主题为中心的焦点小组（FG）讨论，直至达到理论饱和。纳入标准为哮喘诊断且年龄在18岁以上。FG会议进行视听记录，并通过映射技术和根据迈林方法进行的内容分析（由MAXQDA®支持）进行分析。使用Videograph System®计算参与者的发言时间以及用于不同主题的时间比例，并与内容分析相关联。
来自农村和城市地区的13名男性和名24女性，年龄在20至77岁之间，参加了5次FG。一些患者最近被诊断出患有哮喘，另一些患者则是几年前或儿童时期就已患病。讨论了以下主题：（a）对治疗成分的担忧或拒绝，特别是皮质类固醇，这有时会导致自主的、未告知的药物更改；（b）缺乏进行最佳治疗的时间或金钱；（c）在治疗选择方面参与不足；（d）希望获得更大的自主权；（e）医疗保健专业人员之间沟通欠佳；（f）建议与日常生活冲突带来的困难。主要地，（g）参与者希望有更多时间与医生讨论困难以及（h）与患有损害性疾病生活的各个方面。
我们确定了一些由患者驱动的实施AG建议的重要障碍。为了推进AG的实施并改善哮喘治疗，在起草新版本的AG之前需要考虑患者的观点。这些问题应在规划阶段得到解决。
DRKS00000562（德国临床试验注册中心）
