Implementing an Asthma Patient Decision Aid in Primary Care: A Qualitative Study of Clinicians' and Patients' Perspectives on Its Sustainability.

Abstract

Adherence to maintenance asthma inhaled therapy remains suboptimal globally. An asthma patient decision aid (PDA) can facilitate shared decision-making between patients and physicians when selecting asthma treatment options. This study aimed to explore the perspectives of the clinicians and patients in the implementation of this PDA in the primary care practice and to identify optimal delivery approaches for its sustainability. Thirty primary care doctors, nurses, pharmacists, and 20 patients who were prescribed inhaled corticosteroids were interviewed through focus group discussions and individually to gather their perspectives on using a locally designed asthma PDA. The transcribed qualitative data were analysed and presented using the Normalisation Process Theory framework. Platform preferences differed among the patients, with older patients favouring print formats whilst younger patients preferred digital versions. Nonetheless all participants agreed that the PDA should be written in layman's language, have large font sizes, and good visual design. Most of the clinicians highlighted time constraints as a barrier to PDA use and emphasised the need for easy access to the materials during consultations. Clinicians suggested mutual sharing of experiences with the PDA to address implementation hurdles and facilitate integration into clinical practice and workflow, alongside conducting regular content updates. Successful asthma PDA implementation requires multi-format delivery to accommodate diverse patient preferences and streamlined access to address clinician time constraints. Peer sharing and regular content updates are essential for sustained adoption. This study's findings provide practical guidance for integrating the asthma PDA into primary care.