International Primary Care Respiratory Group (IPCRG) Research Prioritisation Exercise: A Qualitative Analysis of the Most Important Respiratory Research Themes Relevant to Primary Care as Viewed by Clinicians Worldwide

Problem

Respiratory diseases impose a substantial burden on global health where over 1 billion people worldwide suffer from respiratory conditions. Primary care has a fundamental role in identifying, diagnosing and managing respiratory diseases and good quality evidence is needed to effectively manage respiratory conditions worldwide. In 2010, the International Primary Care Respiratory Group (IPCRG) published its Research Needs Statement which was followed by an e-Delphi prioritisation exercise in 2012 to identify the most important respiratory research questions that are relevant to primary care. An updated IPCRG research prioritisation exercise that considers a wider range of clinical conditions and embodies global perspectives is currently due. Aim: To identify the most important respiratory research themes from the perspective of primary care clinicians in low-, middle- and high-income countries.

Approach

An online e-Delphi was conducted to prioritise the most important research questions for respiratory primary care. Clinicians who manage people with respiratory conditions in the community were recruited via the IPCRG network of 34 member countries. An initial open questionnaire elicited participants’ views on the most common and important respiratory conditions seen in their daily practice. In addition, they were asked to suggest 5-10 research questions that are relevant to primary care. Here we report a qualitative analysis of participants’ responses to identify the main cross-cutting respiratory research themes relevant to primary care practitioners. Thematic analysis (Using the Braun and Clarke 6-step approach) was conducted using NVIVO software.

Findings

112 participants from 27 countries responded to the open questionnaire and 608 research questions were suggested. The most common and important conditions reported were COPD, asthma and respiratory infections. For common conditions, asthma was the most frequently mentioned single condition (17.2%), followed by COPD (15.2%) and upper respiratory tract infections (URTI) (7.1%). Asthma was the most clinically important condition mentioned (25.7%) followed by COPD (24.5%) and URTI (5.8%). Five main themes emerged from the thematic analysis: uncertainties about the best way to diagnose and treat respiratory conditions in primary care; need for locally relevant and accessible guidance; need to explore methods to better empower patients to manage their own conditions; the role of the wider healthcare team, and the need for simple point-of-care tests in the diagnosis, monitoring and management of respiratory conditions in primary care.

Consequences

Participants suggested a broad range of questions within 5 themes, some of which reflected a basic lack of knowledge of evidence-based guidelines. These results emphasise the need for better methods of educating practitioners to provide evidence-based practice and the development/evaluation of locally relevant approaches accessible and affordable for primary care in all settings. The next stage of the e-Delphi will provide a refined list of relevant research questions for prioritisation.