title: Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study.
abstract: BACKGROUND
  Acute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians' adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics' attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence.
  
  
  METHODS
  We conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data.
  
  
  RESULTS
  Seventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians' and patients' expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma.
  
  
  CONCLUSIONS
  This qualitative study provides insight into paramedics' perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma.
authors.affiliation: Clinical Audit and Research Department, East Midlands Ambulance Service NHS Trust, East Division Headquarters, Cross O'Cliff Court, Lincoln LN4 2HL, England. debbie.shaw@emas.nhs.uk.
authors.forename: Deborah
authors.initials: D
authors.lastname: Shaw
authors.forename: Aloysius Niroshan
authors.initials: AN
authors.lastname: Siriwardena
mesh_terms: D000208:Acute Disease; D000488:Allied Health Personnel; D000552:Ambulances; D001249:Asthma / Q000175:diagnosis / Q000628:therapy; D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration; D004739:England; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research
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