A qualitative questionnaire based study exploring attitudes, beliefs and experiences of patients and healthcare professionals, in relation to short-acting beta-2-agonist and inhaled corticosteroid prescription and adherence

Date of ISAC Approval: 
28/05/2020
Lay Summary: 
We know that over 4 million adults in the UK are currently receiving treatment for asthma. Asthma attacks occur frequently and tragically can result in death. One contributing factor of poor asthma control may be the increased use and over reliance on the 'reliever inhaler' (bronchodilator) and underuse of the 'preventer inhaler' (anti-inflammatory). This study will help us to gain better understanding of patient's views on inhaler usage and why patterns of under use of preventer inhalers and increased use of reliever inhalers have emerged. Furthermore, we will gain better understanding of GP's and Healthcare Professionals' attitudes and approaches to prescribing, how these influence prescribing practices and patient behaviours. There has been little research on patients' experiences relating to high reliever inhaler use. In this study, we will investigate attitudes, beliefs, behaviours and experiences of asthma patients towards their inhaler use, using patient surveys, focus groups and in-depth interviews. GP prescribing behaviours will also be measured through questionnaire surveys and focus groups. These approaches will lead to a better understanding of the reasons and motivations for using the reliever inhaler and how this influences use of the preventer inhaler. This will enable us to develop an approach to influence prescribing practices, leading to better healthcare resource utilization and improved asthma control.
Technical Summary: 
Background: Since 2006, asthma related deaths have declined, however rates in the UK are still higher than Europe, purported to be caused by the under prescribing of inhaled corticosteroids (ICS), over reliance and increased use of short-acting beta-agonists (SABA). The high use of SABA and/or ICS underuse is associated with increased healthcare resource utilization (HRU) and exacerbations resulting in increased morbidity and mortality. This retrospective, observational and cross-sectional qualitative study, aims to understand the experiences patients diagnosed with asthma have with their disease and their relationship with treatment. Additionally, we will gain a better understanding of GP's and Heath Care Professional's (HCP) prescribing behaviours. Methods: CPRD will electronically administer a questionnaire-based survey to 130 research active GP practices who have contributed to CPRD Aurum in the last 6 months. Prior to this a process of critical appraisal will inform development of the GP and patient surveys. A sub-set of 600 patients, aged 18 and over, with a current validated asthma code and registered with an active GP practice will be selected by CPRD. Both surveys will be electronically administered by CPRD and relayed to patients by the GP practices. The patient survey will be hosted on CPRD's online study platform and will be administered by CPRD. The GP survey will be hosted by [Qualtrics] and distributed to GPs by email from CPRD. 35 patients will be invited to participate in the focus group discussions and a further 4-6 patients will be selected to partake in the qualitative in-depth interviews to obtain further information on their perception, experience of asthma symptoms and relationship with SABA treatment. Results: Descriptive statistics will characterise the participating population; proportionate responses (cox regression), trends and frequency calculations will quantify the GP and patient survey data; the audio recordings from the focus groups and in-depth interviews will be analysed using a thematic framework approach to identify common themes and patterns relating to SABA, ICS and prescribing behaviours. NVIVO software will be used to establish categories and themes. Cohen's interrater kappa will be used to test the variability.
Health Outcomes to be Measured: 
Asthma reliever and maintenance medication to be stratified by BTS steps 1-5 and current asthma therapy. Outcomes include: - Prescribing behaviours of HCP's; - SABA (reliever) use, frequency and triggers; - ICS (preventer) use, frequency and triggers; - Patient perspectives, experiences of symptoms and relationship with maintenance therapy.
Collaborators: 

Dr Jennifer Quint - Chief Investigator - Imperial College London
Dr Anne-Marie Russell - Collaborator - Imperial College London
Dr Erin Tomaszewski - Collaborator - Astellas Pharma Europe Ltd. - UK
Dr Mehmet Berktas - Collaborator - Astellas Pharma Europe Ltd. - UK
Miss Rupa Sisodia - Corresponding Applicant - Imperial College London