Optimizing respiratory integrated care models in Ireland: insights from PCP feedback on the early days of integrated chronic disease management pathways.
In 2020 the Irish Health Service Executive (HSE) shifted chronic disease management (CDM), including COPD and asthma, into primary care via a funded CDM programme. An Enhanced Community Care (ECC) initiative established local clinical specialist teams (CSTs) providing spirometry, nurse-led clinics and pulmonary rehabilitation to support primary care practitioners (PCPs). We explored early PCP experience, diagnostic access, and confidence, to identify improvement priorities.
We sought to evaluate PCPs experiences with the implementation of Ireland's CDM and ECC programmes for COPD and asthma, focusing on diagnostic access, clinical confidence and priorities for service improvement and professional development.
A semi-structured survey was distributed nationally through PCP faculty meetings, mailing lists and messaging groups. Single- and multi-choice items, Likert scales (1-10) reported as median and interquartile range (IQR), and ranked options quantified satisfaction, access and educational needs; free-text responses underwent thematic analysis.
One-hundred-12 PCPs responded (62% urban; 65% >10 years in practice). Most practices (97%) had adopted CDM and 87% perceived better patient outcomes arising from this, yet only 33% reported a major change in their own practice. Integrated-care hubs were rated good-excellent by 87% and superior to hospital outpatient care by 84%, but limited diagnostics (52%), delayed two-way communication (45%) and inadequate specialist support (50%) persisted. Self-reported confidence in guideline knowledge was modest (asthma 7 (IQR 6-7); COPD 7 (IQR 6-7)) and very low for interpreting pulmonary-function tests and prescribing pulmonary rehabilitation (3 (IQR 2-5) and 5 (IQR 4-6) respectively). Priority topics for continuing-professional-development were: differentiating asthma from COPD, inhaler device choice and PFT interpretation.Irish PCPs value the CDM/ECC model but highlight implementation gaps. Targeted CPD, faster digital feedback and decision-support tools are needed, alongside longitudinal evaluation against health-service benchmarks and sustainability frameworks.
We sought to evaluate PCPs experiences with the implementation of Ireland's CDM and ECC programmes for COPD and asthma, focusing on diagnostic access, clinical confidence and priorities for service improvement and professional development.
A semi-structured survey was distributed nationally through PCP faculty meetings, mailing lists and messaging groups. Single- and multi-choice items, Likert scales (1-10) reported as median and interquartile range (IQR), and ranked options quantified satisfaction, access and educational needs; free-text responses underwent thematic analysis.
One-hundred-12 PCPs responded (62% urban; 65% >10 years in practice). Most practices (97%) had adopted CDM and 87% perceived better patient outcomes arising from this, yet only 33% reported a major change in their own practice. Integrated-care hubs were rated good-excellent by 87% and superior to hospital outpatient care by 84%, but limited diagnostics (52%), delayed two-way communication (45%) and inadequate specialist support (50%) persisted. Self-reported confidence in guideline knowledge was modest (asthma 7 (IQR 6-7); COPD 7 (IQR 6-7)) and very low for interpreting pulmonary-function tests and prescribing pulmonary rehabilitation (3 (IQR 2-5) and 5 (IQR 4-6) respectively). Priority topics for continuing-professional-development were: differentiating asthma from COPD, inhaler device choice and PFT interpretation.Irish PCPs value the CDM/ECC model but highlight implementation gaps. Targeted CPD, faster digital feedback and decision-support tools are needed, alongside longitudinal evaluation against health-service benchmarks and sustainability frameworks.
Authors
O'Brien O'Brien, McCarthy McCarthy, Lim Lim, O'Carroll O'Carroll, Fitzgerald Fitzgerald, Walsh Walsh, Franciosi Franciosi
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