How do asthma liaison nurses influence inner city asthma care? A qualitative evaluation of the ELECTRA study

Abstract

Objective:

To explore how asthma liaison nurses influence primary care management of people with high risk asthma.

Design:

Qualitative interview study linked to a randomised control trial testing the effectiveness of asthma liaison nurses.

Participants:

Four asthma liaison nurses, one lead respiratory nurse, seven general practitioners, six practice nurses, seven people / carers with acute asthma.

Setting:

Secondary care and general practices in Tower Hamlets, a deprived area in east London.

Results:

Roles of liaison nurses included reviewing people with acute asthma in secondary care and making recommendations to general practices; providing telephone advice for patients and practice nurses; and setting up asthma clinics in underdeveloped practices. There was considerable variability in how liaison nurses influenced general practices. Liaison worked best in practices where practice nurses were confident in managing asthma, where this role was devolved to them by general practitioners and where there was multidisciplinary discussion about asthma care. Liaison nurses helped nurses from these practices identify and follow up high risk patients. By contrast, liaison was ineffective in practices which lacked strategy and did not prioritise asthma.

Patients found the liaison nurses approachable and informative. Self management plans were provided to patients commensurate with patients' capacity, interest and social circumstances. Patients complained that they received conflicting advice from different clinicians. Their main request was for continuity of care with a single clinician whom they could trust.

Conclusions:

Liaison nurses influence care mainly in practices which already prioritise asthma. There are considerable barriers to the effectiveness of asthma liaison nurses in east London.