Meeting the challenges of asthma management guidelines in public primary care clinics in Malaysia: a qualitative study

Aim Global and national asthma guideline recommendations provide standards of care that may be challenging to meet, especially in low- and middle-income countries. We aimed to explore the perspectives of healthcare providers (HCPs) in public primary care clinics on providing guideline-recommended care. MethodHCPs from six public primary care clinics from a semi-urban district of Selangor, Malaysia were invited to participate in audio-recorded focus groups facilitated by semi-structured interviews guides. Transcribed interviews were coded and analysed thematically. Results26 HCPs (family medicine physicians (n=5), medical officers (n=5), medical assistants (n=4), pharmacists (n=4), assistant pharmacists (n=4) and nurses (n=4)) were interviewed in six focus groups. The challenges described related to treatment, follow-up and infrastructure. Limited supplies of inhaled combination therapy (ICS/LABA); patients poor inhalation technique (spacer devices were unavailable) and medication compliance were key treatment-related challenges. Follow up was challenging as patients did not attend, either for the recommended early review after an out-of-hours or hospital emergency attendance, or for regular appointments to enable for continuity of care. Infrastructure such as registry, a dedicated asthma team and standardised operation protocol which could have supported achieving recommendations were not widely established. In addition, multiple programmes which utilised the same human resources and facilities in the clinic had put a huge burden to the staff and clinics; asthma was highlighted as being given less priority compared to other non-communicable diseases that were closely monitored by the ministry. Nonetheless, the HCPs had access to the guidelines and attended training for asthma management. Conclusion Limited resources and lack of infrastructure were highlighted as the challenges for meeting asthma management standards. There is a need for supports from the ministry to address the issues and promote quality improvement programmes for asthma which could facilitate better management of asthma in public primary care clinics. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This project is funded by the National Institute of Health Research (NIHR) RESPIRE Global Health Research Unit, UK References and Clinical Trial Registry Information