The Path to Diagnosis of Severe Asthma-A Qualitative Exploration

Abstract

Sharon R Davis,1 Biljana Cvetkovski,1 Gregory Peter Katsoulotos,2,* Joy W Lee,3,* Janet Rimmer,4,* Natasha Smallwood,3,* Katrina O Tonga,5,* Penelope Abbott,6 Sinthia Z Bosnic-Anticevich1,7 1Woolcock Institute of Medical Research, Macquarie Park, NSW, Australia; 2School of Medicine, Sydney Campus, The University of Notre Dame, Sydney, NSW, Australia; 3Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia; 4Department of Respiratory Medicine, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 5Respiratory Department, Westmead Hospital, Westmead Clinical School, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia; 6School of Medicine, Western Sydney University, Penrith, NSW, Australia; 7Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia*These authors contributed equally to this workCorrespondence: Biljana Cvetkovski, Email [email protected]: Severe asthma poses a significant health burden in those with the disease, therefore a timely diagnosis can ensure patients receive specialist care and appropriate medication management. This study qualitatively explored the patient experience of adult Australians with severe asthma regarding specialist referral, to identify potential opportunities to streamline the process of severe asthma diagnosis and treatment and optimise referral pathways.Patients and Methods: Adults currently being treated with medication for severe asthma were invited to participate in this study. Participants were interviewed and asked to describe initial diagnosis of their asthma or severe asthma, and how they came to be referred to secondary care. Interviews were transcribed verbatim, coded by two members of the research team and thematically analysed.Results: Thirty-two people completed the study; 72% were female. Mean interview length was 33 minutes. The major themes generated were patient-related factors contributing to seeking a severe asthma diagnosis; perceptions of health care provision; diagnosis of severe asthma and the referral journey. Key findings were that both patient and healthcare provider attitudes contributed to participants’ willingness to seek or receive a referral, and referral to respiratory specialists was often delayed. Contributing factors included a mismatch between patient expectations and general practice, lack of continuity of primary care, and a lack of patient understanding of the role of the respiratory specialist.Conclusion: Timely severe asthma diagnosis in Australia appears to be hampered by an absence of a clear referral process, lack of general practitioner (GP) knowledge of additional treatment options, underutilisation of pharmacists, and multiple specialists treating patient comorbidities. Directions for future research might include interviewing healthcare providers regarding how well the referral process works for severe asthma patients, and researching the time between referral and when a patient sees the respiratory specialist.Keywords: respiratory, patient, referral, diagnosis, comorbidities

Keywords

• respiratory
• patient
• referral
• diagnosis
• comorbidities