Barriers to asthma management

Reduce Medical Overuse with the Taking Action on Overuse Framework Another way practices can better serve patients is by eliminating low-value care, such as unnecessary diagnostic tests, treatments or hospitalizations. Medical overuse drives up health care costs, and in some cases, actually harm patients.

Barriers to asthma management

A key determinant of the success of a clinical trial is the recruitment and retention of a study population of an adequate sample size. Low rates of recruitment and retention have a number of negative implications, such as longer durations of the clinical trial, which may lower staff and participant morale; a costlier clinical trial, since extra resources may need to be dedicated to the recruitment effort; and less statistical power for both the study and the validity of the results.

In some cases, inadequate accrual of subjects may result in the termination of the trial. These barriers are already well recognized in the literature. The aim of this article is to examine if the identified barriers are in reality what is encountered by those involved in clinical trials today.

Qualitative data collection Data was obtained on the barriers to recruitment and retention by carrying out in-depth semistructured interviews with a variety of professionals, employed in the United Kingdom, involved in recruitment to Barriers to asthma management trials, both nationally and internationally.

A total of 16 professionals were interviewed, including investigators, representatives from pharmaceutical companies, and representatives from contract Barriers to asthma management organizations. For practical reasons, the qualitative data collection for this study was limited to data collection from professionals in the United Kingdom who are involved in subject recruitment.

Seeking the opinion of study subjects was beyond the scope of this study and would necessitate a further study. Despite the small sample size used and the limited range of professionals interviewed, this study yielded some interesting observations.

The sidebar below lists the barriers found in the literature. While this research showed a strong consistency between the literature and the practical experience of those professionals interviewed, a number of enlightening differences between the accepted barriers and the actual barriers encountered in practice today were identified.

Interview respondents identified the same four broad categories of barrier to recruitment and retention as identified in the literature. Each of the key areas identified is discussed below.

Interviewees identified many similar subject-related barriers to recruitment and retention as has been noted in the literature.

However, some important differences were also noted. According to the literature, long waiting times associated with clinic visits and inconvenient scheduling of appointments are barriers to recruitment and retention.

Secondly, the literature reports that subjects often fail to enter or complete clinical trials as they dislike the uncertainty associated with the trial, and in many cases prefer the doctor to make the decision about their treatment.

It may also reflect the growing knowledge among the public of medical-related matters perhaps as a result of people having greater access to information available on the Internet coupled with their concerns about risk.

However, public concerns about risk do not appear to conform to scientific or technical measures of risk, with an extensive body of literature having been written on this topic. A useful overview is provided by Slovic.

Interviewees reported that subjects who have unrealistic expectations of the clinical trial may be reluctant to complete the study protocol. Such expectations could imply a problem with the informed consent process, with details of the requirements associated with trial participation being poorly communicated to subjects.

This may result in reduced retention, with subjects dropping out prior to trial completion. These have not been conclusively recognized as barriers in the literature. Interviewees also noted that people are tending to change jobs more frequently and are moving to new locations to take up these jobs.

Moving out of the area is an increasing potential barrier to subjects completing trial protocols. This has not been widely reported in the literature, but is likely to become an issue if such trends continue within the work force.

Despite investigators agreeing to recruit subjects to a clinical trial, many factors related to the trial investigator may prevent them recruiting adequate subject numbers. The main barriers identified in the literature may be divided into logistical factors and personal factors. The recruitment and retention barriers identified in the literature review and by those interviewed were broadly consistent, but as with the subject-related barriers, some revealing differences were also noted.

Barriers to asthma management

An inability of the recruiting physicians to integrate their roles as caregivers with that of scientists is identified in the literature as a barrier to recruitment and retention. Many factors reported by those interviewed as being investigator-related barriers to recruitment and retention were not widely cited in the literature.This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review.

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Culturally sensitive, holistic and collaboratively designed interventions are needed.

Health Informatics Journal: SAGE Journals