Edinburgh Napier University

  Background: Self-management improves outcomes in asthma and COPD and is strongly recommended in national and international guidelines; however implementation of the guidelines such as use of written action plans in practice is often poor.

Setting: A questionnaire survey was undertaken to identify the healthcare professional barriers to im-plementation of self-management for asthma and COPD in West London.

Question: Why is self-management education not being undertaken in respiratory conditions?

Methods: A questionnaire was designed to elicit healthcare professionals’ views about barriers to implementation of self-management in asthma and COPD.

Results: Response rates were 33% (58/175). Results showed strong support for guideline recommenda-tions, however implementation was patchy. Seventy six percent of respondents discussed asthma self-management with patients; however only 47.8% of patients received a written action plan. For COPD patients, 55.1% discussed self-management, with 41% receiving a written action plan. In COPD, there was greater GP involvement and less delegation of self-management. Barriers to implementation in-cluded patient factors (compliance, literacy and patient understanding), time constraints and in-sufficient resources. Those who believed they had witnessed improved health outcomes with self-management (53%, 31/58) were more likely to give written action plans (78%, 24/31, ‘nearly always/ sometimes’ gave written action plans), Nearly a third of healthcare professionals reported lacking confidence in constructing written action plans (33% 19/58; GPs 43%, nurses 43%).

Conclusion: Despite overwhelming evidence self-management support is still not being implemented into routine clinical practice, identified barriers included time constraints, lack of training, lack of belief in patients ability to self-manage and lack of confidence completing self-management plans.

Practice implications: These issues need to be addressed if self-management support is to be delivered in a meaningful and effective way.