title: A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care.
abstract: BACKGROUND
  Asthma management in Australia is suboptimal. The "Guidelines for provision of aPharmacist Onlymedicine: short acting beta agonists" (SABA guidelines) and a novel West Australian "Asthma Action Plan card" (AAP card) were concurrently developed to improve asthma management. The aim of this qualitative research was to evaluate the collaborative, multidisciplinary and multifaceted implementation of these asthma resources and identify the lessons learnt to inform future initiatives.
  
  
  METHODS
  Feedback was sought about the implementation of the SABA guidelines and the AAP card using focus groups with key stakeholders including pharmacists (×2), pharmacy assistants, asthma educators, general practitioners, practice nurses and people with asthma (patients). Audio recordings were transcribed verbatim. Data were analysed thematically using constant comparison. The common themes identified from the focus groups were categorised according to a taxonomy of barriers including barriers related to knowledge, attitudes and behaviour.
  
  
  RESULTS
  Seven focus group sessions were held with 57 participants. Knowledge barriers were identified included a lack of awareness and lack of familiarity of the resources. There was a significant lack of awareness of the AAP card where passive implementation methods had been utilised. Pharmacists had good awareness of the SABA guidelines but pharmacy assistants were unaware of the guidelines despite significant involvement in the sale of SABAs. Environmental barriers included time and workflow issues and the role of the pharmacy assistant in the organisation workflows of the pharmacy. The attitudes and behaviours of health professionals and patients with asthma were discordant and this undermined optimal asthma management. Suggestions to improve asthma management included the use of legislation, the use of electronic resources integrated into workflows and training pharmacists or practice nurses to provide patients with written asthma action plans.
  
  
  CONCLUSIONS
  Greater consideration needs to be given to implementation of resources to improve awareness and overcome barriers to utilisation. Attitudes and behaviours of both health professionals and patients with asthma need to be addressed. Interventions directed toward health professionals should focus on skills needs related to achieving improved communication and patient behaviour change.
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia ; Pharmacy Program, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009 Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Watkins
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: Colleen
authors.initials: C
authors.lastname: Fisher
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
authors.forename: Jila
authors.initials: J
authors.lastname: Misaghian
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schneider
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Clifford
keywords: Asthma; Community pharmacy; Focus groups; Guidelines; Resources; Stakeholders