Review management for children with asthma in primary care: a qualitative case study.

Aims Of The Study: To present an overview of review management of childhood asthma in one UK primary care trust with respect to organization and perceptions of key stakeholders and children's and families' needs.

Background: Review management of childhood asthma in primary care is important in addressing the continuing high levels of morbidity. However, the delivery of this service appears to be fragmented, so it is not known how well primary care asthma clinics function. Children's, parents' and professionals' perceptions of such clinics and the roles they play within them are also poorly understood.

Research Design: A qualitative case study design was used in the study. This is a form of enquiry that investigates contemporary issues within their real life contexts, using particular situations within the case to describe important phenomena.

Methods: Eighteen children, 16 parents, 14 practice purses and 14 general practitioners from 14 general practices in one primary care trust were interviewed. Review appointments were observed and asthma-related documentation examined.

Findings: Key findings point to diversity in the service and that key stakeholders' view practice nurses as primarily responsible for the review management. However, there are issues related to their levels of responsibility, other health professionals' roles and interdisciplinary communication. Finally, families felt some of their needs were neglected and professionals reported uncertainties in providing family-centred care.

Conclusions: This case study indicates that responsibility for review consultations in childhood asthma needs to be formalized, including a more proactive and family-centred approach. There are implications for the practice nurse role regarding professional education and preparation for family-centred care.

Relevance To Clinical Practice: This paper shows that unstructured, diverse care delivery persists in primary care; children and their families identify both strengths and unmet needs in review management visits; and professionals have uncertainties about providing effective child and family-centred care.