Abstract

The overuse of short-acting beta2 agonists (SABA) in asthma management is associated with poorer outcomes with higher rates of morbidity and death. There are also environmental implications, with SABA-only inhalers accounting for 2.1% of UK carbon emissions. The Sentinel Plus Project, funded by AstraZeneca and co-developed with Hull York Medical School and Hull University Teaching Hospitals NHS Trust, aims to address these areas by reducing SABA overuse. The Project uses a package of resources focusing on core topics including patient/clinician education and gold-standard prescribing. We undertook a qualitative case study in the East of England region to identify any enablers or barriers to delivery and to understand the processes required for effective practice change.

This was a multi-case, mixed methods exploratory case study. Semi-structured interviews were conducted with local respiratory network leads, project managers and healthcare professionals working within the Primary Care Networks. Thematic analysis was performed using modified Braun and Clarke’s coding framework.

The participants described three main themes influencing the outcome of the Project. The first was that staff and patient education was paramount, with face-to-face delivery being highlighted as a significant enabler to aid understanding. The second was that the delivery of the Project necessitated increased workforce and resource capacity, requiring recognition and support from managerial teams. Thirdly, all participants spoke strongly of the need to understand the motivating behaviours of staff and patients with respect to asthma management, which strongly impacted their level of engagement with the Project.

This case study identifies some of the key processes required for effective implementation of the Sentinel Plus Project. The spontaneous themes that arose demonstrate the COM-B behavioural change framework in action – Capability (education and knowledge), Opportunity (physical resource capacity) and Motivation (engagement). Understanding these drivers for behavioural change provides the opportunity for effective practice change in future.