Optimal medical management in primary care for individuals with chronic breathlessness (OptiMed): evidence synthesis using national guidelines and qualitative methods

BACKGROUND: Chronic breathlessness poses a significant burden for individuals and healthcare systems. Effective symptom-directed approaches, such as breathing and relaxation techniques, require medical optimisation of the underlying long-term condition causing breathlessness. We previously identified nine, predominantly cardiorespiratory, long-term conditions contributing to the greatest burden of breathlessness in primary care. AIM: Develop checklists to support primary care in delivering optimal, evidence-based management of conditions causing chronic breathlessness. DESIGN & SETTING: Synthesis of national guidance and stakeholder workshops, using a co-design approach. METHOD: Desktop review of national guidance relating to the management of each condition was synthesised as the basis for the checklists. Virtual workshops and interviews were conducted to further adapt the checklist content with stakeholders (primary care staff, clinical specialists, and representatives from national speciality groups). Workshops were recorded and facilitated by a qualitative researcher with clinical experience. Insights from workshop data were incorporated to produce draft checklists for verification by workshop participants. Checklist contents were refined and agreed in consultation with national specialist groups. Electronic patient record templates were developed to operationalise the checklists. RESULTS: Twenty-two national guidelines were reviewed and synthesised into the checklist drafts. Six virtual workshops and nine individual interviews were conducted with 30 key stakeholders (five GPs, four nurses, six physiotherapists, three pharmacists, three dietitians, and nine physicians). Participants directed the checklist format to include safety netting, key diagnostic checks, and optimal management. CONCLUSION: Short, pragmatic, evidence-based checklists were developed for use in primary care to support primary care clinicians in managing the main conditions contributing to chronic breathlessness.