Skene Imogen, Griffiths Chris, Pike Katherine, Bloom Benjamin Michael, Pfeffer Paul, Steed Liz
Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
Barts Health NHS Trust, London, UK.
Emerg Med J. 2025 Aug 19;42(9):608-614. doi: 10.1136/emermed-2024-214407.
Guidelines recommend Emergency Department (ED) healthcare professionals (HCPs) ensure patients have a supply of inhaled corticosteroid on discharge after an acute asthma presentation. By optimising medication, acute asthma presentations to EDs are a potentially reachable moment to improve long-term asthma management as well as treating the acute exacerbation. Optimising medication for long-term asthma management requires behavioural changes from HCPs, which may be considered unacceptable or unfeasible. Understanding health beliefs and attitudes of HCPs who provide asthma treatment in emergency care is a critical step in determining whether interventions could be developed to address this.
To explore the health beliefs, attitudes and behaviours of HCPs involved in the care of adult patients presenting to the ED with asthma.
UK HCPs, purposively sampled for profession, experience and work setting, were invited to participate in a semi-structured face-to-face or online interview. These were conducted between November 2021 and June 2022. Eligible participants had experience of caring for patients with asthma in either the ED or primary care setting. Interviews were analysed with reflective thematic analysis.
19 HCPs were interviewed. Four themes were identified, constructed around the beliefs and behaviours of HCPs: (1) Compassionate understanding, that is, recognising the accessibility of ED, patients' self-management and the emotional aspects of exacerbations, (2) Doing what is right for the patient, that is, maximising a reachable moment, (3) Tensions of capacity in the system, that is, acknowledging workload within ED and (4) ED as providers of preventative care.
This study found HCPs recognise both the accessibility of the ED as a place for patients to seek help and that there are potential opportunities to optimise asthma control, but there are barriers to overcome. ED professionals may be willing to make changes in the best interests of the patients if they can follow guidelines and receive training.
指南建议急诊科医护人员确保急性哮喘发作的患者出院时备有吸入性糖皮质激素。通过优化药物治疗，急诊科的急性哮喘发作是改善长期哮喘管理以及治疗急性加重的一个潜在可及时机。优化长期哮喘管理的药物治疗需要医护人员改变行为，而这可能被认为是不可接受或不可行的。了解在急诊护理中提供哮喘治疗的医护人员的健康信念和态度是确定是否可以制定干预措施来解决这一问题的关键一步。
探讨参与护理成年哮喘急诊患者的医护人员的健康信念、态度和行为。
有目的地根据职业、经验和工作环境对英国医护人员进行抽样，邀请他们参加半结构化的面对面或在线访谈。访谈于2021年11月至2022年6月进行。符合条件的参与者在急诊科或初级保健机构有护理哮喘患者的经验。访谈采用反思性主题分析法进行分析。
对19名医护人员进行了访谈。确定了四个主题，围绕医护人员的信念和行为构建：（1）同情理解，即认识到急诊科的可及性、患者的自我管理以及加重发作的情感方面；（2）为患者做正确的事，即最大限度地利用可及时机；（3）系统中的能力紧张，即承认急诊科的工作量；（4）急诊科作为预防保健的提供者。
本研究发现医护人员认识到急诊科是患者寻求帮助的可及场所，并且存在优化哮喘控制的潜在机会，但也有障碍需要克服。如果急诊科专业人员能够遵循指南并接受培训，他们可能愿意为患者的最大利益做出改变。
