Introduction Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists. Aim To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA. Methods We employed a qualitative phenomenological methodology and undertook 20–45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated. Results Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets. Conclusion Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification. Data are available upon reasonable request.

中文翻译：

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初级保健专业人员识别职业性哮喘的障碍：一项定性研究


简介 职业性哮喘 (OA) 占成人哮喘病例的六分之一，并带来巨大的社会成本。许多 OA 病例被遗漏或延误，导致持续接触病原体、本可避免的肺功能丧失和不良的就业相关结果。医疗保健专业人员 (HCP) 对工作相关症状和工作性质的询问有限，这在初级和二级护理中很明显。造成这种情况的潜在原因是时间压力、缺乏专业知识以及很难接触到专家。目标 了解主要 HCP 中可能构成识别 OA 障碍的组织因素、信念和行为。方法 我们采用定性现象学方法，对英国西米德兰兹郡的主要 HCP 进行了 20-45 分钟的访谈。我们采用有目的的滚雪球抽样方法，将来自城市和农村地区的全科医生 (GP) 和具有丰富经验的执业护士纳入其中。采访以数字方式记录并专业转录以供分析。数据由手工编码，并进行主题分析并从理论上确定，直到主题饱和。结果 11 名 HCP 参与（8 名全科医生，3 名护士）。确定了四个被认为影响 OA 识别的主题：(1) 培训和经验，(2) 观念和信念，(3) 系统限制，以及 (4) 个人实践的变化。在培训和实践的每个阶段，针对 OA 的教育都不够充分，并且对 OA 的临床接触普遍有限。对 OA 的具体看法各不相同，工作年龄的哮喘患者的临床行为也各不相同。人们关注的是诊断和治疗，而不是归因因果关系。 已确定的有关哮喘护理组织的问题包括时间限制、缺乏连续性、转诊压力、指南和模板的使用以及外部目标。结论 哮喘初级护理的组织和实施、与 OA 相关的消极信念、缺乏正规教育以及接触 OA 目前都可能抑制其识别。数据可根据合理要求提供。