Defining high probability when making a diagnosis of asthma in primary care: a mixed methods consensus workshop: a mixed methods consensus workshop

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Abstract

Objectives Making the diagnosis of asthma is challenging. Guidelines recommend that clinicians identify a group at ‘high probability’ of asthma. ‘High probability’, however, is not numerically defined giving rise to uncertainty. The aim of this work was to build consensus on what constitutes a ‘high probability’ of asthma in primary care. ‘High probability’ was defined as the probability threshold at which there is enough information to make a firm diagnosis of asthma and a subsequent negative test would not alter that opinion (assumed to be a false negative).
Design Mixed methods study
Setting A consensus workshop using modified Nominal Group Technique was held during an international respiratory conference.
Participants International conference attendees eligible if they had knowledge/experience of working in primary care, respiratory medicine and spoke English.
Methods Participants took part in facilitated discussions and voted over three rounds on what constituted a high probability of asthma diagnosis. The workshop was audio-recorded, transcribed and qualitatively analysed.
Results Based on final votes, the mean value for a high probability of asthma in primary care was 75% (SD 7.6), representing a perceived trade-off between limiting the number of false positives (more likely if a lower threshold was used) and pragmatism on the basis that first-line preventive therapies (i.e. low-dose inhaled corticosteroids) are relatively low risk. The need to review response to treatment was strongly emphasised for detecting non-responders and reviewing the diagnosis.
Conclusion A consensus probability of 75% was the threshold at which the primary care participants in this workshop felt confident to establish the diagnosis of asthma, albeit with the caveat that a review of treatment response was essential. Contextual factors including availability and timing of tests and the ease with which patients could be reviewed influenced participants decision making.
Original languageEnglish
JournalBMJ Open
Early online date20 Apr 2020
DOIs
Publication statusE-pub ahead of print - 20 Apr 2020

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