Self-management in asthma and COPD?

Background Self-management (SM) improves outcome in long-term conditions. SM is strongly recommended in asthma guidelines. In chronic obstructive pulmonary disease (COPD) the evidence in favour is increasing. Use is poorly implemented in asthma with only a few studies as to why. Less is known about healthcare professionals views’ about SM in COPD.

Methods A questionnaire study of healthcare professionals views’ on SM plans in asthma and COPD was sent to respiratory SpRs and consultants in North London and a GP+nurse in 31 GP practices in one PCT. This abstract summarises the quantitative results.

Results 54/176 questionnaires were returned from 18/55 GPs, 13/41 nurses, 13/63 SpRs and 10/17 consultants. Over 90% of respondents agreed/strongly agreed with the British asthma guideline recommendation on SM. Two-thirds occasionally and 10% never issued action plans. Respondents reported discussing SM with 76% of their patients. GPs estimated that 34% of patients received plans; consultants estimated the highest (70%). 90% believed that patients should receive a plan during a hospital admission. 25% of doctors reported undertaking SM education with patients compared with 61.5% of nurses. 80% occasionally/never asked to see a patient’s plan which they had not issued. 52% believed they had witnessed improved outcomes using SM, of which 75% always/sometimes gave plans to patients. Nurses most commonly issued asthma plans (61.5%) compared with SpRs (38.5%) and GPs (27.8%). Overall, 18/54 (33%) of respondents felt they lacked confidence constructing an asthma plan, of which 8/18 (44%) were GPs and 6/18 (33%) were nurses. 80% of respondents strongly/agree with NICE recommendation on SM in COPD but 40% did not feel plans were as valuable as in asthma. 54% discussed COPD SM with patients. Respondents believed 40% of patients received COPD plans with higher levels reported by consultants (67%). Again nurses issue most of the plans (69.2% vs 61.5% in asthma), but GPs were more involved in SM in COPD (50%) than in asthma (33.3%).

Conclusions Despite strong support for guideline recommendation, implementation was patchy. Consultants reported greater involvement but, overall, nurses were the most likely to give action plans. A third lack confidence in completing an action plan. In COPD there was greater GP involvement.