Remote support for asthma self-management acceptable, safe and effective
A systematic rapid realist review has shown that remote delivery of supported self-management provide multiple patient benefits
A systematic rapid realist review published in the journal, Health Expectations, has found that remote delivery of supported self-management for asthma was generally clinically effective, acceptable, and safe with the added advantage of increasing accessibility.
Supported self-management is an approach that facilitates patients with long-term conditions like asthma to have the knowledge, skills, and confidence to manage the physical, emotional and social impact of their condition. Previous evidence shows that supported self-management improves asthma control, reduces asthma attacks and hospital admissions and improves patients’ quality of life.
In response to the global COVID-19 pandemic, UK GPs had a dramatic shift from face-to-face consultations to telephone, video and online appointments. Remote consultations can potentially provide both benefits and challenges for patients and health professionals. This rapid realist review enabled the researchers from the Asthma UK Centre for Applied Research to understand if and how remote consultations work and in what clinical, demographic and organisational contexts.
The study aimed to:
- Identify and synthesize studies that evaluated and/or explored remote asthma consultations and the delivery of supported self-management.
- Explore the context and mechanisms that have contributed to clinically effective, safe and acceptable delivery of supported self-management during remote asthma consultations.
- Produce recommendations for best practices in the delivery of supported self-management during remote consultations for people with asthma.
Following realist review methodology, 18 articles including grey literature were included in the rapid realist review and comprised of studies conducted between 2003 and 2020 in the UK, the USA, Canada and Italy.
Six themes were identified from the articles which described how supported self-management is delivered during remote asthma consultations. Positive benefits associated with remote asthma consultations included:
- increased convenience
- improved access (including for some vulnerable groups) and attendance at reviews,
- ability to assess the core content of asthma remotely (especially video reviews that enabled practical tasks such as checking inhaler technique),
- completion of asthma action plans (screen sharing or discussed with documents sent postconsultation)
- continuity of care
These positive benefits overrode any challenges associated with distance imposed by remote consultations and the patient’s concerns about the quality of the interaction.
For many patients and healthcare professionals, remote consultations are more highly accepted than in-person consultations, and were equally as effective and safe as face-to-face reviews.
The researchers suggest that future research explores how telecommunication can be implemented in ways that are most valued by patients and clinicians, to fit within the organisational and technical infrastructure of healthcare services, while embracing the culture of delivering supported self-management.
This study is part of the Centre’s IMPlementing IMProved Asthma self-management as RouTine IMP2ART programme of work which has developed evidence-based, practical strategies to promote the delivery of supported self-management in routine primary care. This rapid realist review provides evidence-based findings of the underlying contexts and mechanisms in remote service provision that contribute towards effective supported self-management delivery during asthma reviews, which will be highlighted by the IMP2ART programme.
Emma Kinley, lead author on the study and PhD student within the IMP2ART and the Centre, believes that this work can inform the conduct of remote asthma reviews, and implementation of supported self-management techniques into asthma care. She said:
The results of the study suggest remote delivery of supported self-management for asthma was found to be clinically effective, acceptable and safe with the added advantage of increasing accessibility. The findings support the option of remote delivery of routine asthma care and provide possible guidance for healthcare professionals conducting routine asthma reviews remotely, to successfully embed supported self-management techniques into individual consultations. These findings will be further explored within my PhD study which investigates health professional delivery of supported self-management for asthma within the IMP2ART (IMPlementing IMProved Asthma Self-Management As RouTine) programme of work. The systematic realist review findings, in conjunction with observational recordings of routine asthma reviews and interviews with health professionals, will add to the interpretations to assess health care professional delivery of patient-centred care and behaviour change strategies to promote self-management.
Find out more about Emma’s PhD study and the IMP2ART programme of work
Read the review
Kinley, E, Skene, I, Steed, E, Pinnock, H, McClatchey, K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect. 2022; 1- 15. doi:10.1111/hex.13441