Abstract

Introduction: Chronic breathlessness causes significant burden to individuals and healthcare systems, and is typically managed in relation to the underlying cardiorespiratory disease.
Aim: We aimed to develop checklists to support primary care staff in delivering optimal, evidence-based management of the underlying conditions causing chronic breathlessness, using a co-design approach.
Methods: We used a rapid evidence review to identify conditions contributing to the greatest burden of breathlessness in primary care. National guidance relating to the management of each condition was synthesised as the basis for the checklists. A series of virtual workshops were conducted to agree checklist content. Stakeholders were invited including primary care staff, clinical specialists and representatives from national speciality groups. Workshops were facilitated by a qualitative researcher with clinical experience, recorded and transcribed verbatim. Workshop data were critically appraised and insights incorporated to produce draft checklists for verification by workshop participants. To operationalise the checklists, electronic patient record templates were developed.
Results: The conditions contributing to the greatest burden of breathlessness in primary care were identified as Asthma, Chronic Obstructive Pulmonary Disease (COPD), Lung cancer, Bronchiectasis, Interstitial Lung Disease (ILD), Heart Failure, Atrial Fibrillation, Valvular Heart Disease and Obesity. Four virtual workshops and two individual interviews were conducted with 29 key stakeholders (5 general practitioners, 4 nurses, 6 physiotherapists, 3 pharmacists, 3 dieticians, 8 physicians). Checklist content were refined and agreed in consultation with national specialist groups including BTS and PCRS. Participants directed the checklist format to include safety netting, key diagnostic checks and optimal management (Figure 1. Example COPD checklist).
Conclusion: We developed short pragmatic evidence-based checklists to support primary care clinicians in managing the main conditions contributing to chronic breathlessness in primary care. The OptiMed checklists have stand-alone value in primary care and will be used to ensure optimal management in the national PrimaryBreathe trial.