Self-treatment of asthma: possibilities and perspectives from the practitioner's point of view.

OBJECTIVES Self-management of asthma is becoming more and more widespread. The implementation of this treatment strategy requires changes in the role and attitude of the GP. These changes may be hindered by obstacles both expected and experienced. As self-treatment of asthma is more common in the UK, comparison between UK and Dutch GPs provides a good opportunity to identify possible obstacles in general practice to the implementation of self-treatment of asthma with inhaled corticosteroids. METHODS We carried out a qualitative descriptive study with self-administered questionnaires and interviews. Questionnaires were sent to 500 randomly selected Dutch GPs. Interviews were held with 20 Dutch and 25 British GPs in order to acquire more in-depth information. The outcome measures were attitude towards, knowledge regarding and experiences with self-treatment of asthma; organizational requirements; and expectations of consequences of self-treatment in general practice. RESULTS The Dutch and British GPs investigated have a positive attitude towards self-treatment of asthma. Though knowledge about self-treatment is present among a majority of the GPs, self-treatment by patients is not yet as common in The Netherlands as it is in the UK. Nineteen per cent of the Dutch GPs had experience with a written peak-flow-based self-treatment plan related to the usage of inhaled steroids. According to our findings, present expected obstacles are probably mainly of the organizational kind, such as the availability of time, money and materials. CONCLUSIONS There is a positive attitude towards the implementation of self-treatment plans in general practice, but problems relating to certain identified obstacles need to be addressed. There is a need to define which patients might profit from self-treatment, and further proof of both the clinical effectiveness and the cost-effectiveness of self-treatment needs to be acquired.