Background/rationale
The COVID pandemic has forced a dramatic change in the organisation of primary care, including a move to remote consulting (NHS, 2020). In response to COVID-19, the IMP2ART implementation strategy (a programme of work aiming to support asthma self-management in primary care) is being adapted to the delivery of supported self-management in remote asthma reviews. Remote reviews encompass telephone reviews (available for many years); video-calls which have been instigated in response to the pandemic, and ‘on-line questionnaires/consultations’ which have increasingly been used to complement, and in some cases replace, synchronous reviews. Little is known about how these on-line reviews are being used, and if/how they achieve reviews acceptable and useful to patients, perceived as effective and safe by clinicians and how their use is organised in the context of routine primary care.
Asthma reviews have many functions including addressing the patient’s concerns and questions; assessing control and reviewing medication; and supporting self-management. Supported self-management of asthma, which includes provision of a written asthma action plan and regular medical review, helps people adjust their treatment in response to changes in symptoms, and studies have shown that it improves day-to-day control and reduces the need for healthcare services (Pinnock et al., 2017). Despite policy drives to technological innovation (NHS, 2020), and promotion by patient organisations (Asthma UK), it is not clear how asthma reviews can be delivered in remote – or more specifically on-line – consultations. Some preliminary work has recently been completed exploring the technical feasibility of shared online completion of an action plan (Hamour et al., 2020), and this PhD project would expand on this work.
The PhD student will explore, from a patient, health care professional and organisational perspective, how on-line asthma reviews are perceived and used in the context of multiple modes of consulting. The student will then compile a toolkit including organisational procedures to support safe use of on-line/remote reviews and test the feasibility of the implementation this guidance in routine primary care.
Aims
This PhD aims to explore the use of on-line asthma reviews (in the context of multiple modes of consulting) from the perspective of patients, healthcare professionals and managers, to develop processes for safe use of on-line reviews and to test their feasibility in routine primary care.
Objectives:
- To undertake a systematic review of existing approaches to on-line asthma reviews
- To explore the feasibility, acceptability, perceived effectiveness, safety and organisational context of implementing on-line (and other modes of) asthma reviews from the perspective of all stakeholders.
- To develop safe procedures for safe use of on-line reviews (and other modes of consultation)
- To test the feasibility of implementing the on-line review procedure