Table 1.

Partnership between patient and/or carer and HCP

Sub-theme	Summary of findingsa,b
Communication between HCP and patient	• There is a perceived need for better communication between patient and HCP; for the patient to be included/acknowledged in the consultation; and for the patient to have a respectful relationship with their GP22,24,29,38,44,54,61–63,73,74 (P/Ca/HCP).
	• Patients who have a mutually trusting relationship with their HCP have confidence in their own understanding of asthma, avoid ED re-attendance44, and are more likely to adhere to SM advice61 (P).
	• Patients want GPs to take an interest in them and try to understand their experience38,54,59 (P). Some GPs need to learn about patients’ personal circumstances by listening to the patient, in order to develop a relationship and improve medication taking behaviour21,62 (P/ R).
	• GPs value and seek acknowledgement for the skills they use in persuading patients to take medications properly46 (HCP).
	• Some people with intellectual disabilities are frustrated when HCPs talk to their carers rather than directly to them60 (P)
	• Some carers value nurse communication with their children and intervene in consultations between their child and HCP to clarify information provided by the child (Ca). Nurses want to hear from the child, not just the carer during consultation52 (HCP).
	• Non-focused questions give more opportunity for children to influence the agenda of consultations but children find it easier to respond to focused questions52 (R).
	• Patient advocates can sometimes facilitate communication through interactions with patients21 (P).
	• Some HCPs aim to be empathic, non-judgmental and open; putting themselves in the patient’s shoes63 (HCP)
Continuity and consistency of care	• There is a perceived need for continuity of care to avoid patient and carer frustration and assessment difficulties for clinicians and to develop an effective patient-GP partnership22,24,29,34,59 (P/Ca).
	• HCPs do not always give consistent advice regarding treatment decisions, and are not always consistent in tailoring medication to the patients’ or carer’s routines24,74 (P/Ca).
	• If the patient/carer perceives inconsistent advice is given by different GPs or by the same GP on different occasions, they can become confused. This might lead to patients being unlikely to go to the GP for future help74 (P/Ca).
	• Some HCPs use strategies to prevent patients re-attending the ED, such as: targeting high risk patients; offering ‘privileged access’; and providing out of hours continuity of care44,63 (HCP).
Patient/carer perception of GP care as ineffective or inadequate	• Some patients, particularly South Asian, African American, and low health literate patients and carers, feel their GP or other primary care providers do not effectively treat them38,43,74 and view care as substandard. Some perceive that treatment is quicker and more efficient through the ED, rather than through their GP and report being more satisfied with advice given by nurses, A&E doctors, and pharmacists37,45,74 (P/Ca).
	• When treatment is not perceived as effective and subsequent changes in treatment are also not deemed effective, patients sometimes become non-compliant with their treatment and avoid asthma management advice50 (R).
	• HCPs are reported as being good at dealing with symptoms but some patients expect them also to locate the cause of asthma and would prefer longer consultation times43,48,73 (P).
	• Some carers have a lack of confidence in the GP’s advice and search among different doctors to find an effective way to manage their asthma65 (Ca), particularly as some GPs are seen as unhelpful, and not providing enough information to patients45 (P).
	• Children are concerned that medications do not work.26 Young people and adolescents, particularly African American adolescents, do not perceive the need for regular, routine health care visits33,73 (Ch/P).
	• Some carers perceive there is reluctance for GPs to prescribe steroids when it is necessary74 (Ca) and that diagnosis is not accurate, diagnosing a less severe condition, e.g., coughing being attributed to an ear infection rather than asthma29 (Ca).
	• Carers who stop their children taking medications due to perceived ineffectiveness still visit the hospital for asthma attacks75 (Ca/R).

^a SM self-management, GP general practitioner, ED emergency department, CAM complementary and alternative medicine, HCP health care professional, WAAP written asthma action plan, PEF peak expiratory flow

^b Type of person who expressed their viewpoint (P patient viewpoint, HCP health care professional viewpoint, Ca carer viewpoint, Ch child/adolescent’s viewpoint, R researcher’s viewpoint)