Evaluation Study of Childhood Bronchial Asthma Prevention and Treatment Services by Primary Care General Practitioners in Chongqing

Abstract

Background Bronchial asthma (asthma) is the most common chronic respiratory disease in childhood, with long disease course and repeated attacks, which affecting the development and life quality of children. As the main providers of primary healthcare, general practitioners play important role in the early diagnosis and grading management of childhood asthma. Understanding their level of prevention and treatment services for this disease can provide suggestions for improving the quality of primary care childhood asthma prevention and treatment services. Objective To investigate the service level of primary general practitioners in the prevention and treatment of childhood asthma, and the influencing factors on the service level. Methods From April to July 2022, 22 districts (counties) were randomly selected from the 38 districts (counties) in Chongqing Municipality, and conducted a questionnaire survey on primary general practitioners in the sampling. The questionnaire was designed by the research team based on relevant guidelines and literatures, and formed through two rounds of expert consultation and pre-investigation, including four dimensions of knowledge, attitude, behavior and self-evaluation. We investigated the knowledge, attitude, behavior and self-evaluation of primary general practitioners regarding the prevention and treatment of childhood asthma and analyzed the influencing factors. Results A total of 234 general practitioners participated in the questionnaire survey. The knowledge score of general practitioners on the prevention and treatment of childhood asthma was (6.03±2.04) , with a pass rate of 44.9%; the attitude score was (49.42±4.94) , with a pass rate of 100.0%; the behavior score was (30.55±6.66) , with a pass rate of 87.2%; and the self-evaluation score was (21.57±5.30) , with a pass rate of 85.0%. Regarding the selection of referral indications, 98.7% (231/234) of the general practitioners believed that children with moderate or severe acute asthma attack that was not significantly relieved after emergency treatment needed to be referred, and 94.0% (220/234) of the general practitioners believed that children with asthma that could not be controlled effectively after standardized treatment needed to be referred. For children with poorly controlled symptoms, 33.8% (79/234) of the general practitioners would carefully analyze the cause of poor control, and 17.5% (41/234) of the general practitioners would advise patients to follow the doctor's advice, temporarily observe the condition and make an appointment for next reexamination. 33.8% (79/234) of the general practitioners held an uncertain or opposed attitude towards the diagnosis and treatment of childhood asthma in primary medical institutions. The main influencing factors of this attitude was the lack of disease-related knowledge and learning opportunities for general practitioners, reluctance of parents to visit primary medical institutions, strained pediatric doctor-patient relationship, the small number of children suffering from asthma, and the lack of related facilities and equipment. Multiple linear regression analysis showed that professional title and training experience on childhood asthma were the influencing factors of knowledge score (P<0.05) ; academic qualification and years of service in primary medical institutions were the influencing factors of attitude score (P<0.05) ; and pediatric work experience and training experience on childhood asthma were the influencing factors of behavior and self-evaluation scores (P<0.05) . Conclusion The general practitioners in Chongqing have some confidence in the management of children with asthma, but their knowledge of asthma prevention and treatment is poor. Their attitude and behavior were both positive, but there is a gap between the two. It is suggested that while optimizing the allocation of pediatric facilities and equipment in primary medical institutions and improving the trust of patients, knowledge and practical training is important to improve the knowledge, confidence and abilities of general practitioners. Academic education and continuing education training of general practitioners should be strengthened to effectively improve their learning and self-improvement ability.

Keywords

• asthma|primary care|general practitioners|herarchical diagnosis and treatment|children