Recommendation areas Barriers to implementation Facilitators to implementation Audit criteria Resource implications
Implementation of a structured, multidisciplinary transition programme involving paediatric and adult HCP for 11-25 year age group Organization challenges reorganising service to deliver a paediatric/ adult clinic. Training for staff, checklist of skills and knowledge for AYA patients, regular meetings between adult and paediatric teams, audit process. Existence of a 11-25 year transition clinic. Some initial investment may be required to reorganise the clinical service.
Medication reminders, mobile applications and web-based applications, monitors or routines to improve adherence, symptom control and quality of life Convincing families to change their routines. Expense of information technology applications or monitors. The use of alarm functions on devices such as mobile phones. Adherence to therapy. Simple changes to routines to facilitate adherence or the use of alarm functions on devises such as mobile phones are inexpensive. Separate mobile or web-based applications would be expensive.
Focusing consultation on areas where AYA say they are not confident to improve self-management including adherence Changing HCP approach which focuses on a set approach to history taking in clinic. Training for HCP so they understand the mind set of AYA and behavioural change approaches. Survey of AYA patients to assess their confidence in self-management. Resources for training HCP.
Formulation of a personal action plan with the AYA and their family to enable them to self-manage their allergy and asthma Time to develop patient specific self-management plans. Generic personal action plans that can be personalised to the needs of specific patients. Possession of personal action plan by individual patients. Time to develop patient specific self-management plans.
Peer-led interventions to improve asthma related quality of life, asthma knowledge and to reduce asthma related doctor visits and school absence Resistance and expense of involving peers in training AYA. Availability of peers who have the same condition. Education of HCP about the benefit of peer-led interventions. Asthma related quality of life and control after peer-led interventions. Expense of involving peers in training AYA.
Supporting the AYA, family and the wider community to allow the AYA inclusion in social events Resistance from teachers, sport club leader and others in the community. Education of teachers, sport club leader and others in the community as to how to safely manage the risks associated with allergy and asthma. Access to social events by patients with allergy and asthma. Costs associated with training and education.
Motivational interviewing to improved asthma symptoms and quality of life Lack of time and expertise. Training for HCP and knowledge about how improved self-management can reduce further healthcare utilisation. Asthma related quality of life and control after use of motivational interviewing. Expense of training and increased clinic time, initially.
Identification and management of psychological and socioeconomic issues impacting disease control and health related quality of life Lack of time in clinic to identify and assist in managing these. Training in AYA care and awareness of importance of psychological and socioeconomic issues. Survey of psychological and socioeconomic issues. Cost of additional clinic time. Access to a psychologist within the allergy service.
Psychological interventions using a cognitive behavioural therapy based or multi-systemic therapy approach to improve adherence, asthma knowledge, self-management and symptom control Lack of time and expertise. Training for HCP and knowledge about how improved self-management can reduce further healthcare utilisation. Health related quality of life and symptom control after use of these psychological interventions. Expense of training and increased clinic time, initially. Access to a psychologist within the allergy service.
Enrolling the family in assisting the AYA to take on the self-management of their allergy and asthma Inflexible family routines and lack of time. Involvement of families in clinic and explanation of benefits of their support. Health related quality of life and symptom control after use of these psychological interventions. Cost of possible additional clinic time.
Encouraging AYA to let their friends know about their asthma and allergy and how to manage emergencies AYA embarrassment and concern that they will be seen as different. Explanation that friends will be interested in helping them. Survey of the involvement in friends in supporting self-management. Cost of possible additional clinic time. Plus resources directed at friends.
Signposting AYA to high quality online resources about allergy and asthma where they can obtain age-appropriate information and advice may be recommended Information on websites or from forums that provided an inaccurate picture of allergy and asthma. High quality websites or moderated forums that can inform and support AYA with allergy and asthma. Survey the use of website and moderated forum. Costs associated with developing and maintaining websites and moderated forums.