Challenges for asthma units in response to COVID-19: a qualitative group dynamics analysis

To develop a set of recommendations for the management of severe asthma during COVID-19 pandemic. Eleven pneumologists and allergologists who were staff members of officially accredited asthma units in Catalonia (Spain) participated in a cross-section study based on three 2-hour virtual workshops (first: brainstorming, second: identification of impacts and challenges summarized in 10 topics, third: establishment of final recommendations by consensus). Impacts and challenges identified were improvement of referral protocols between different levels of care; assessment of the minimum number of function tests to be performed and promote the performance of spirometry in primary care; implementation of videoconferencing, mobile apps, telephone calls, or integral virtual platforms for the follow-up of patients, and definition of the model of care (face-to-face, telematics, mixed) according to the patient’s individual needs; self-administration of biologics for domiciliary treatment; and empowerment of the role of nursing and hospital pharmacy in particular for follow-up and self-administration of biologics. The main recommendations included coordination between primary care and specialized care consultation, optimization of lung function testing, implementation of telemedicine, and the role of nursing and hospital pharmacy. The specific proposals in response to the effect of COVID-19 pandemic focused on four areas of interest (coordination between primary care and specialized care, optimization of lung function testing, implementation of telemedicine, and empowerment of the role of nursing and hospital pharmacy) may be generalized to other health care settings, and help to introduce new ways of caring asthma patients in the COVID-19 context.

为制定新冠疫情期间重度哮喘的临床管理推荐意见，来自西班牙加泰罗尼亚地区官方认证哮喘诊疗中心的11名肺科医师及变态反应科医师参与了一项依托三场2小时线上研讨会开展的横断面研究：第一场为头脑风暴环节，第二场用于梳理归纳为10个主题的相关影响与挑战，第三场则通过共识研讨制定最终推荐意见。研究识别出的影响与挑战包括：不同层级医疗体系间转诊流程的优化；明确所需开展的最低限度肺功能检查项目，并推动基层医疗开展肺量计检查（spirometry）；启用视频会议、移动应用、电话随访或整合式虚拟平台开展患者随访，并依据患者个体需求确定照护模式（线下、远程、混合模式）；居家治疗用生物制剂（biologics）的自助给药；以及强化护理人员与医院药师的角色，尤其在生物制剂的随访及自助给药方面。本次研究的核心推荐意见涵盖基层医疗与专科医疗的协作衔接、肺功能检查流程优化、远程医疗（telemedicine）的落地实施，以及护理与医院药师的职能赋能。针对新冠疫情影响提出的专项建议聚焦四大领域（基层与专科医疗协作、肺功能检查优化、远程医疗推广、护理与医院药师角色赋能），这些建议可推广至其他医疗场景，有助于在新冠疫情背景下探索重度哮喘患者照护的全新路径。