Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
UM eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
NPJ Prim Care Respir Med. 2021 Nov 29;31(1):47. doi: 10.1038/s41533-021-00257-5.
Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.
在中低收入国家，实施哮喘指南建议具有挑战性。我们旨在探讨医疗保健提供者（HCP）对提供推荐护理的看法。根据角色和经验，从马来西亚一个半城市地区的六家公共初级保健诊所中有意选择了 26 名 HCP 进行焦点小组讨论。讨论由半结构化访谈指南指导，并进行主题分析。HCP 可以获得指南和培训，但强调了实施推荐护理的多个与基础设施相关的挑战。分别由于肺活量计的使用受限和哮喘控制测试（ACT）的使用有限，哮喘控制的诊断和评估受到阻碍。治疗决策受到吸入性联合疗法（ICS/LABA）和免费喷雾器装置可用性差的限制。涉及其他非传染性疾病的卫生部计划被优先于哮喘计划。如果质量改进计划要促进公共初级保健诊所中哮喘的更好管理，部长级政策需要实际资源和组织支持。
