Long‐term exposures to air pollutants and risk of major adverse cardiovascular events (maces), a nationwide 10‐year open cohort study in taiwan

diseases. Methods: The study used a mixed method convergent design using quantitative and qualitative data collected simultaneously. Quantitative survey was conducted to 32 health care providers and 160 patients in 25 Puskesmas and 7 hospitals in 3 selected districts. Qualitative survey was performed to 25 health care providers, 8 patients, 3 program managers at District Health Office through in depth interview and focused group discussion. Results: (a) Availability of drugs and infrastructures; only 30–50% of drugs in the national guideline is available in Puskesmas. Reliever and controller drugs are limited. (b) Health staff; Health staffs lack of capacity to recognize the sign and symptoms of asthma, and the use of asthma devices especially in Puskesmas. (c) Implementation of SOP; All health care facilities in this study have SOP for asthma services but the adherence is not as expected. (d) Patient Care; Education, Information and Consultation (EIC) has been conducted focusing on asthma triggers. Majority of patients did not comply to medications. (e) Clinical Leadership; The relevant Medical Associations have not been consistently collaborate with District Health Office or Provincial Health Office in asthma. Conclusion: Multidimensional gaps in health care facilities for asthma patient need to be addressed. The Ministry of Health of Indonesia sets a program to prioritize tackling asthma disease; 1) Encourage collaborations to uplift health staffs capacity, 2) Provision of drugs, especially controllers and nebulizer devices in Puskesmas, and 3) Include counselling as a standard service for patients in current guidelines for asthma.