J.S.QUEK1, W.E.TANG1, S.H.TEO1, ELYA1, H.E.SMITH2
National Healthcare Group Polyclinics1, Nanyang Technological University2
Asthma is highly prevalent in Singapore. Despite the availability of preventer medications, many patients present to public primary care clinics (polyclinics) with asthma exacerbations requiring nebulisation. We wanted to examine patients’ journeys to nebulisation, focussing on the reasons behind any delay in seeking urgent medical care.
Face-to-face semi-structured interviews were conducted with patients who received nebuliser therapy for asthma exacerbation at a polyclinic. Data was used to construct themes.
Fifteen multi-ethnic patients aged 22 to 62 were recruited. Participants often described a baseline of poorly-controlled asthma – barriers included cost, underuse of preventer medication and difficulties attending routine care due to work. Five reasons for delay were identified: inability to access polyclinic afterhours, adverse impact of absenteeism on employment, perception that exacerbation was ‘not serious enough’, difficulty recognising symptoms of asthma exacerbation, and being tired or despondent. Participants were triggered to seek care when symptoms persisted despite reliever use, were prolonged, and interfered with sleep or work. Some sought care due to advice from others. During an acute asthma episode, participants often initiated other self-management measures besides reliever use, including over-the-counter medications and non-pharmacological interventions like drinking water and massage. Of the 15 participants, only one stepped up preventer inhaler adequately, according to Asthma Action Plan (AAP).
Patients delayed seeking medical attention for their asthma exacerbation due to various reasons. Polyclinics can collaborate with nearby private General Practitioner (GP) clinics, better communicate afterhours care options and adopt a multi-disciplinary team approach in asthma care. AAP counselling should also be personalised.