Davis Sharon R, Cvetkovski Biljana, Katsoulotos Gregory Peter, Lee Joy W, Rimmer Janet, Smallwood Natasha, Tonga Katrina O, Abbott Penelope, Bosnic-Anticevich Sinthia Z
Woolcock Institute of Medical Research, Macquarie Park, NSW, Australia.
School of Medicine, Sydney Campus, The University of Notre Dame, Sydney, NSW, Australia.
Int J Gen Med. 2024 Aug 19;17:3601-3611. doi: 10.2147/IJGM.S435347. eCollection 2024.
Severe asthma poses a significant health burden in those with the disease, therefore a timely diagnosis can ensure patients receive specialist care and appropriate medication management. This study qualitatively explored the patient experience of adult Australians with severe asthma regarding specialist referral, to identify potential opportunities to streamline the process of severe asthma diagnosis and treatment and optimise referral pathways.
Adults currently being treated with medication for severe asthma were invited to participate in this study. Participants were interviewed and asked to describe initial diagnosis of their asthma or severe asthma, and how they came to be referred to secondary care. Interviews were transcribed verbatim, coded by two members of the research team and thematically analysed.
Thirty-two people completed the study; 72% were female. Mean interview length was 33 minutes. The major themes generated were patient-related factors contributing to seeking a severe asthma diagnosis; perceptions of health care provision; diagnosis of severe asthma and the referral journey. Key findings were that both patient and healthcare provider attitudes contributed to participants' willingness to seek or receive a referral, and referral to respiratory specialists was often delayed. Contributing factors included a mismatch between patient expectations and general practice, lack of continuity of primary care, and a lack of patient understanding of the role of the respiratory specialist.
Timely severe asthma diagnosis in Australia appears to be hampered by an absence of a clear referral process, lack of general practitioner (GP) knowledge of additional treatment options, underutilisation of pharmacists, and multiple specialists treating patient comorbidities. Directions for future research might include interviewing healthcare providers regarding how well the referral process works for severe asthma patients, and researching the time between referral and when a patient sees the respiratory specialist.
重度哮喘给患者带来了沉重的健康负担，因此及时诊断可确保患者获得专科护理和适当的药物管理。本研究定性探索了成年澳大利亚重度哮喘患者在专科转诊方面的经历，以确定简化重度哮喘诊断和治疗流程以及优化转诊途径的潜在机会。
邀请正在接受重度哮喘药物治疗的成年人参与本研究。对参与者进行访谈，询问他们哮喘或重度哮喘的初始诊断情况，以及他们是如何被转诊至二级护理的。访谈内容逐字转录，由研究团队的两名成员进行编码并进行主题分析。
32人完成了研究；72%为女性。平均访谈时长为33分钟。产生的主要主题包括导致寻求重度哮喘诊断的患者相关因素；对医疗服务提供的看法；重度哮喘的诊断及转诊过程。主要发现是患者和医疗服务提供者的态度都影响了参与者寻求或接受转诊的意愿，而且转诊至呼吸专科医生的时间往往延迟。促成因素包括患者期望与全科医疗不匹配、初级护理缺乏连续性以及患者对呼吸专科医生角色缺乏了解。
在澳大利亚，及时诊断重度哮喘似乎受到以下因素的阻碍：缺乏明确的转诊流程、全科医生对额外治疗选择的知识不足、药剂师利用不足以及多名专科医生治疗患者的合并症。未来研究的方向可能包括就转诊流程对重度哮喘患者的效果如何访谈医疗服务提供者，以及研究转诊与患者见到呼吸专科医生之间的时间间隔。
