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Patient Preferences for Asthma Management: a Qualitative Study

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Patient Preferences for Asthma Management: a Qualitative Study Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-037491 on 16 August 2020. Downloaded from Patient preferences for asthma management: a qualitative study Christina Baggott ,1 Amy Chan ,2 Sally Hurford,1 James Fingleton ,1 Richard Beasley ,1 Matire Harwood ,3 Helen K Reddel ,4 William Mark Magnus Levack 5 To cite: Baggott C, ABSTRACT Strengths and limitations of this study Chan A, Hurford S, et al. Objective Preference for asthma management and the Patient preferences for use of medications is motivated by the interplay between ► A broad approach to exploring the patient experi- asthma management: a lived experiences of asthma and patients’ attitudes qualitative study. BMJ Open ence of asthma, its management and preferences towards medications. Many previous studies have focused 2020;10:e037491. doi:10.1136/ for management enabled a novel analysis of patient on individual aspects of asthma management, such as bmjopen-2020-037491 preferences and patient experiences of asthma that the use of preventer and reliever inhalers. The aim of this influence their preferences. ► Prepublication history and qualitative study was to explore the preferences of patients ► Participants were from a wide range of backgrounds, additional material for this with mild-modera te asthma for asthma management as a with over 50% identifying as Māori, the indigenous paper are available online. To whole and factors that influenced these preferences. view these files, please visit people of New Zealand, who have a higher preva- Design A qualitative study employing qualitative the journal online (http:// dx. doi. lence of asthma and poorer asthma outcomes. descriptive analysis situated within a constructionist org/ 10. 1136/ bmjopen- 2020- ► A limitation of the study was that the majority of par- epistemology to analyse transcribed audio recordings from 037491). ticipants were women (23/27), which may affect the focus groups. transferability of these finding to men. Received 11 February 2020 Setting Three locations within the greater Wellington area Revised 01 June 2020 in New Zealand. Accepted 02 July 2020 Participants Twenty- seven adults with self- reported doctor’s diagnosis of asthma, taking short-acting beta- well- being.1 2 Patients describe shortness of agonists alone or inhaled corticosteroids with or without breath, chest tightness and impact of asthma long- acting beta - agonist, who had used any inhaled 2 on physical activities as specific troubling asthma medication within the last month. symptoms.3 4 Previous qualitative studies5 Results Four key areas described preferences for 6 http://bmjopen.bmj.com/ asthma management. Preferences for self- management: and a meta-synthesis of qualitative studies participants wanted to be in control of their asthma and found people with asthma are motivated by developed personal strategies to achieve this. Preferences the interplay between lived experiences of for the specific medications or treatment regimen: asthma, the effect asthma has on desired © Author(s) (or their participants preferred regimens that were convenient activities and their attitudes towards medica- employer(s)) 2020. Re- use and reliably relieved symptoms. Preferences for inhaler tions. People with asthma learn to live with permitted under CC BY- NC. No devices: devices that had dose counters and were easy their asthma and adapt how they take medica- commercial re- use. See rights to use and portable were important. Preferences for and permissions. Published by tions and access healthcare according to their asthma services: participants wanted easier access to on September 30, 2021 by guest. Protected copyright. BMJ. preferences and experiences. their inhalers and to be empowered by their healthcare 1 In asthma, poor adherence to daily inhaled Medical Research Institute of providers. Participant preferences within each of these New Zealand, Wellington, New corticosteroids (ICS) and inappropriate reli- four areas were influenced by the impact asthma had on Zealand ance and overuse of short-acting beta-agonists 2 their life, their health beliefs, emotional consequences of School of Pharmacy, The (SABA) for symptom relief are common- University of Auckland, asthma and perceived barriers to asthma management. 7 8 Auckland, New Zealand Conclusions This study illustrates the interaction of place and represent significant problems 3Te Kupenga Hauora Maori, the lived experience of asthma, factors specific to the as these patterns of behaviour are associated University of Auckland, individual, and factors relating to asthma treatments in with increased symptom burden and exacer- Auckland, New Zealand shaping patient preferences for asthma management. bations.9 The intermittent nature of symp- 4 Woolcock Institute of Medical This aids our understanding of preferences for asthma toms and overestimation of asthma control10 Research, University of Sydney, management from the patient perspective. Glebe, New South Wales, means treatment is often suboptimal and Trial registration number Australian New Zealand Australia adherence to daily preventer inhalers prob- Clinical Trials Registry (ACTRN12619000601134). 11 5Department of Medicine, lematic. This is particularly true for indig- University of Otago, Wellington, enous peoples,12 including Māori of New New Zealand Zealand13 who are disproportionately affected 14 Correspondence to INTRODUCTION by asthma and adverse asthma outcomes. Dr Christina Baggott; Living with asthma has a significant impact Qualitative and population- based studies christina. baggott@ mrinz. ac. nz on patients’ physical and psychological show patients preferentially take reliever Baggott C, et al. BMJ Open 2020;10:e037491. doi:10.1136/bmjopen-2020-037491 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-037491 on 16 August 2020. Downloaded from inhalers over preventer inhalers;7 15 this is supported attending and could bring a support person if they signed by pharmacy records as more prescriptions for SABA a confidentiality agreement. are dispensed than ICS.16 When deciding whether to take inhalers, patients weigh- up (consciously or subcon- Data collection sciously) the perceived risks and benefits.17 18 Decisions We collected data via five one- off focus groups conducted relating to treatment engagement are influenced by between 7 May 2019 and 19 August 2019 at the Medical patients’ expectations and perceptions, which may be Research Institute of New Zealand (central city), an misinformed. For example, patients may have low expec- after- hours medical centre (urban site) and a commu- tations of what treatment can achieve,19 have concerns nity centre in an outer suburb. We used a variety of loca- about taking inhalers and use of inhaled corticosteroids tions to increase the participation of people from diverse or believe they are only needed intermittently.20 21 In addi- backgrounds. Focus groups were conducted face-to- face. tion, there is evidence that patients would prefer to take Before the discussion started, participants were asked to a combined preventer and reliever inhaler in response to complete a short survey collecting basic demographics, symptoms over a daily preventer inhaler with a reliever information on current inhaler use and asthma control inhaler for symptom relief.22 (online supplementary file). Previous studies such as these have examined specific Focus groups were audio-recorded and transcribed aspects of patient preferences for asthma management, verbatim. Groups lasted 60–80 min with two facilita- but there is a paucity of information from a holistic tors—either CB (a respiratory specialist doctor), AC (a perspective investigating patient preferences and prior- pharmacist) or SH (a nurse)—experienced in qualitative ities for asthma management as well as the factors methodologies and began with an introduction to the that might influence preferences. To improve asthma research. A discussion guide was used, developed prior management and outcomes it is important to understand to the commencement of the study (online supplemen- the patient perspective for asthma management as whole tary file) informed by the study aims, review of the liter- as they experience it rather than individual components ature on patient preferences for asthma management, such as preferences for inhalers. In this qualitative study, beliefs about asthma medications and the Necessities the aim was to explore adult patients’ experiences of Concerns Framework proposed by Horne et al.27 MH asthma and preferences for asthma management. provided a review of the discussion guide from a Māori perspective. The discussion was semi-structured, between participants with prompts and questions from facilitators. METHODS The discussion guide was iterated as appropriate based Study design on preliminary analysis of data from preceding groups. Methods and results are reported according to the Focus groups continued until thematic saturation was Consolidated Criteria for Reporting Qualitative Research achieved—when two groups had been conducted with http://bmjopen.bmj.com/ guidelines (see online supplementary file).23 A qualitative no new themes emerging. Brief notes were made during descriptive analysis situated within a constructionist epis- the group, and CB reflected on each group afterwards. temology was employed to describe patient preferences For participants who requested it when giving consent, for treatment.24 All participants were given written infor- a transcript of their own data were
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