Expectations and attitudes in primary care towards home-based testing for diagnosing asthma: a mixed methods study.

Background

Asthma is frequently misdiagnosed because clinic-based tests miss its natural variability.

Aim

As part of early stakeholder engagement, we examined primary-care healthcare professionals (HCP)' views on using handheld spirometer and fractional exhaled nitric oxide (FeNO) for home-based diagnostic testing.

Design & setting

This is a two-phase mixed-method study. Phase 1 involved two focus groups with primary care HCPs in North-West England. Phase 2 involved a national electronic survey distributed to primary-care HCPs across the UK.

Method

We used Nominal Group Technique in focus groups to identify key priorities for home-based asthma strategy, which informed the development of the national survey in Phase 2.

Results

Twenty-one primary care HCPs took part in focus groups. Advantages, challenges and facilitators for implementing home-based asthma diagnostics were identified. A total of 104 primary care HCPs completed all survey questions. Respondents represented a wide demographic and practices across all levels of socioeconomic deprivation. Only 3% considered home-based diagnostics strategy is unlikely to be feasible. The most frequently cited barrier was high device cost, while patient engagement and device accessibility were identified as the most important enablers. Most respondents highlighted more accurate asthma diagnosis as key potential benefits.

Conclusion

Home-based asthma diagnosis using handheld spirometry and FeNO is generally viewed favourably by primary care professionals based on survey findings, though implementation challenges are multifaceted. Success will require system-level changes in how home-based testing is delivered and supported. The subsequent phase involves evaluation of test feasibility and accuracy, followed by assessment of clinical and cost-effectiveness.