Multidisciplinary co-operation in primary care for asthmatic children

In the development of 'education protocols' for the treatment and education about chronic diseases in primary care the involvement of several disciplines of careproviders must often be taken into account. This implies that tasks will have to be divided across several disciplines. An orderly way to do this does not seem to have been suggested in the literature. In this paper a systematic technique is presented to divide educational tasks across disciplines. The basic idea of this method is that one should link up as far as possible with existing task conceptions and knowledge of the disciplines involved. The general description of the technique will be followed by a piece of research in which the technique is applied to protocol development for parents of asthmatic children (0-4 years). The protocol aims at allocating specific asthma education tasks to community nurses, general practitioners, asthma nurses and doctors working at child health centers in the Netherlands. This paper focuses mainly on results for community nurses. Three criteria were considered in assigning tasks to the different careproviders: whether the discipline in question claimed a certain task; whether the other three disciplines agreed with the claim, and whether the discipline in question had appropriate and sufficient knowledge about asthma to perform the task correctly. Community nurses did claim several tasks in asthma care, but knowledge did not always seem to be sufficient. Additional results indicated that nurses who had taken a refresher course did have a higher knowledge level than nurses who had not taken such a course. Regular contact with asthmatic children also tended to be associated with increased knowledge of asthma. The implications of these findings for the asthma education protocol are discussed.