Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey

Abstract

Background. Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement.

Methods. The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II).

Results. In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups.

Conclusions. The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.