title: Barriers to the implementation of self management support in long term lung conditions.
abstract: Background Self-management improves outcomes in asthma and COPD and is strongly recommended in national and international guidelines; however implementation of the guidelines such as use of written action plans in practice is often poor. Setting A questionnaire survey was undertaken to identify the healthcare professional barriers to implementation of self-management for asthma and COPD in West London. Question Why is self-management education not being undertaken in respiratory conditions? Methods A questionnaire was designed to elicit healthcare professionals' views about barriers to implementation of self-management in asthma and COPD. Results Response rates were 33% (58/175). Results showed strong support for guideline recommendations, however implementation was patchy. Seventy six percent of respondents discussed asthma self-management with patients; however only 47.8% of patients received a written action plan. For COPD patients, 55.1% discussed self-management, with 41% receiving a written action plan. In COPD, there was greater GP involvement and less delegation of self-management. Barriers to implementation included patient factors (compliance, literacy and patient understanding), time constraints and insufficient resources. Those who believed they had witnessed improved health outcomes with self-management (53%, 31/58) were more likely to give written action plans (78%, 24/31, 'nearly always/sometimes' gave written action plans), Nearly a third of healthcare professionals reported lacking confidence in constructing written action plans (33% 19/58; GPs 43%, nurses 43%). Conclusion Despite overwhelming evidence self-management support is still not being implemented into routine clinical practice, identified barriers included time constraints, lack of training, lack of belief in patients ability to self-manage and lack of confidence completing self-management plans. Practice implications These issues need to be addressed if self-management support is to be delivered in a meaningful and effective way.
authors.affiliation: Research Fellow in Complex Interventions, Glasgow Caledonian University, Institute for Applied Health Research/School of Health and Life Sciences, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Roberts
authors.affiliation: Former MPH Student, Imperial College London, NHLI Division at Charing Cross Hospital, UK.
authors.forename: I
authors.initials: I
authors.lastname: Younis
authors.affiliation: Research Fellow in Public Health, Glasgow Caledonian University, Institute for Applied Health Research/School of Health and Life Sciences, UK.
authors.forename: L
authors.initials: L
authors.lastname: Kidd
authors.affiliation: Professor of Respiratory Medicine, Imperial College London, NHLI Division at Charing Cross Hospital, UK and Senior Vice Dean, The Lee Kong Chian School of Medicine, A Joint School by Imperial College and the Nanyang Technological University, Singapore.
authors.forename: M R
authors.initials: MR
authors.lastname: Partridge
keywords: COPD; asthma; consultation; self-management