Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study

Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident techniq ue and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults With asthma (49 admitted to ho spital with asthma, 9 not admitted); 17 general practitioners; 5 accident a nd emergency doctors; 2 out of hours general practitioners; 1 asthma specia list nurse. Main outcome measures Patients' and health professionals' views on influenc es on admission, events leading to admission, general practices' organisati on and asthma strategies, doctor-patient relationship, and cultural attitud es to asthma. Results South Asian and white patients admitted to hospital coped different ly with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and oft en expressed less confidence in their general practitioner. South Asians ma naged asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were register ed with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships wi th their general practitioner, had better confidence to control asthma, and were registered with practices with Well developed asthma strategies that included policies low avoiding hospital admission. Conclusions The different ways of coping with asd)ina exacerbations and acc essing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control ast hma, confidence in the general practitioner, understanding of preventive tr eatment, and use of systemic corticosteroids in exacerbations may reduce ho spital admissions. Development of more sophisticated asthma strategies by p ractices with better access and partnerships with patients tray also achiev e this.