Papers

A qualitative study of action plans for asthma

Jo Douglass, staff specialist, ^a Rosalie Aroni, lecturer, ^b Dianne Goeman, research officer, ^c Kay Stewart, senior lecturer, ^d Susan Sawyer, associate professor, ^e Frank Thien, staff specialist, ^a Michael Abramson, associate professor. ^f

^a Department of Allergy, Asthma and Clinical Immunology, Alfred Hospital and Monash University, Prahran, Victoria 3181, Australia, ^b School of Public Health, La Trobe University, Bundoora, Victoria 3083, Australia, ^c Co-operative Research Centre for Asthma, Camperdown, NSW 2050, Australia, ^d Victorian College of Pharmacy, Monash University, Parkville, Victoria 3052, Australia, ^e Centre for Adolescent Health, Royal Children's Hospital and University of Melbourne, Parkville, Victoria 3052, Australia, ^f Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria 3181, Australia

Correspondence to: J Douglass j.douglass{at}alfred.org.au

Objectives: To investigate the perspectives of patients with asthma on the use of an action plan and the implementation of this plan during an asthma attack that culminated in a visit to an emergency department.
Design: Qualitative study.
Setting: Tertiary teaching hospital, suburban hospital, and rural hospital.
Participants: 62 patients aged 18 to 69 years who presented to an emergency department with asthma over a two month period.
Results: 29 participants described having action plans given to them by their doctors. Most patients with action plans reinterpreted their plan from the perspective of their own experiences with asthma. 33 patients did not have an action plan, the most common reason being that they had not been given one by their doctor. Some occupational groups were significantly less likely to have been given an action plan by their doctor than others. Most patients with an action plan found them useful for management of their asthma.
Conclusions: Action plans were viewed positively by patients. Participants modified their prescribed plan according to their experience of asthma. To facilitate the implementation of a prescribed action plan, doctors need to acknowledge and include the patient's personal experience of their disease.

What is already known on this topic Action plans for the self management of asthma are standard and have been shown to improve patient outcomes and to protect against death from asthma when provided in written form Factors that enable patients with asthma to implement an action plan and their perspectives on the use of such plans have not been explored in an individual context What this study adds Most patients with action plans found them useful Most patients modified their plans according to their perceptions of severity and likely disease outcome Clinicians must engage with a patient's experience of asthma to facilitate the use of an action plan