Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi.
Patients with difficult-to-manage asthma represent a heterogeneous subgroup of asthma patients who require extensive assessment and tailored management. The International Primary Care Respiratory Group approach emphasises the importance of differentiating patients with asthma that is difficult to manage from those with severe disease. Local adaptation of this approach, however, is required to ensure an appropriate strategy for implementation in the Dutch context. We used a modified three-round e-Delphi approach to assess the opinion of all relevant stakeholders (general practitioners, pulmonologists, practice nurses, pulmonary nurses and people with asthma). In the first round, the participants were asked to provide potentially relevant items for a difficult-to-manage asthma programme, which resulted in 67 items. In the second round, we asked participants to rate the relevance of specific items on a seven-point Likert scale, and 46 items were selected as relevant. In the third round, the selected items were categorised and items were ranked within the categories according to relevance. Finally, we created the alphabet acronym for the categories 'the A-I of difficult-to-manage asthma' to resonate with an established Dutch 'A-E acronym for determining asthma control'. This should facilitate implementation of this programme within the existing structure of educational material on asthma and chronic obstructive pulmonary disease (COPD) in primary care, with potential for improving management of difficult-to-manage asthma. Other countries could use a similar approach to create a locally adapted version of such a programme.
Department of Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
Persijn J
PJ
Honkoop
Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Hilary
H
Pinnock
COPD Astma Huisartsen Advies Groep (CAHAG), Vught, The Netherlands.
Regien M M
RM
Kievits-Smeets
Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Peter J
PJ
Sterk
Department of Pulmonary Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
P N Richard
PN
Dekhuijzen
Department of Pulmonology, STZ Centre of Excellence for Asthma and COPD, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.
Johannes C C M
JC
In 't Veen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D003697:Delphi Technique; D019468:Disease Management; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners; D017410:Practice Guidelines as Topic; D016730:Program Development; D000072106:Pulmonologists; D055815:Young Adult