scholarly journals Facilitators and Barriers to the Implementation of the Primary Care Asthma Paediatric Pathway: A Qualitative Analysis

Author(s):  
Heather Sharpe ◽  
Melissa Potestio ◽  
Andrew Cave ◽  
David Johnson ◽  
Shannon D. Scott

Abstract ObjectiveThe Primary Care Asthma Paediatric Pathway (PCAPP) included an EMR embedded pathway that provided an evidence-based approach to paediatric asthma management. The aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the PCAPP in primary care.Methodsa randomized cluster-controlled design was implemented in 22 primary care practices in Alberta, Canada with half receiving the PCAPP intervention and the other half receiving usual care. Following the implementation of the complex intervention, a purposeful sample of intervention sites were selected to participate in qualitative focus groups to assess the barriers and facilitators to the implementation.ResultsOur qualitative findings are organized into three themes using the core constructs of the normalization process theory (NPT): (1) facilitators of implementation, (2) barriers to implementation, and (3) proposed mitigation strategies. Participants were positive about the pathway, and felt it served as a reminder of optimal paediatric guideline-based asthma management, a streamlined pathway multi-faceted approach to suggest evidence-based care, and an EMR-based targeted collection of tools and resources. Barriers included a generally low priority for the primary care teams, and, in accordance, clinicians suggested they had few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified clear mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a work-flow that incorporated the pathway.ConclusionOur study demonstrated the applicability of the NPT in the implementation of an evidence-based pathway for primary care. This study demonstrated it is important to ensure teams participate in enrolment (establishing buy-in), legitimization (ensuring teams see their role in the pathway) and activation (an ongoing plan for sustainability). Had these components of cognitive participation been addressed more carefully prior to implementation there may have been greater uptake, and ongoing use of the pathway. Trial Registration: This study was registered at clinicaltrials.gov on June 25, 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1

Author(s):  
Ayşe Nur Usturali Mut ◽  
Zeliha Aslı Öcek ◽  
Meltem Çiçeklioğlu ◽  
Şafak Taner ◽  
Esen Demir

AbstractAimTo develop the Primary care fUnctions oF Family physicians in Childhood Asthma (PUFFinCA) scale for evaluating the cardinal process functions of primary care services (accessibility, comprehensiveness, continuity and coordination) provided by family physicians (FPs) in the management of childhood asthma.BackgroundIn the literature on the functions of primary care, there is no assessment tool focusing on children with asthma. Primary care assessment scales adapted to various languages are not suitable to adequately address the needs of special patient groups, such as children with asthma.MethodsIn this methodological study, the instrument development process was completed in four stages: establishing the pool of items, evaluating the content validity, applying the scale and statistical analysis. The scale was applied to 320 children who had asthma and received care in the clinic of the Department of Pediatrics, Division of Allergy and Pulmonology at Ege University School of Medicine, Turkey. The Cronbach’s α and Spearman–Brown coefficient were calculated to determine the reliability of the scale. Principal component analysis was used to determine the construct validity of the scale.FindingsThe PUFFinCA scale was found to have four-factor structure and 25 items. Cronbach’s α coefficient was 0.93. It has been determined that the reliability was excellent and the item-total correlation coefficients were >0.30 each. The factors were titled FP’s ‘functions of accessibility, first contact and continuity’, ‘functions of coordination and comprehensiveness of health services related to asthma management’, ‘provision of preventive care related to asthma’ and ‘provision of services for paid vaccinations’.


2004 ◽  
Vol 82 (4) ◽  
pp. 631-659 ◽  
Author(s):  
AMY M. KILBOURNE ◽  
HERBERT C. SCHULBERG ◽  
EDWARD P. POST ◽  
BRUCE L. ROLLMAN ◽  
BEA HERBECK BELNAP ◽  
...  

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 85-85
Author(s):  
Jennifer R. Klemp ◽  
Becky N. Lowry ◽  
Judy A Johnston ◽  
Kyla Alsman ◽  
Danielle Peereboom ◽  
...  

85 Background: While evidence-based guidelines for survivorship care exist, implementation in oncology and primary care practices has fallen short. There is little evidence of the barriers preventing successful implementation in rural primary care and oncology practices. We sought to assess knowledge gaps and barriers to successful implementation of evidence-based survivorship care guidelines in rural Kansas practices. Methods: Midwest Cancer Alliance, outreach arm of the University of Kansas Cancer Center, and Kansas Patients and Providers Engaged in Prevention Research, completed interviews in rural primary care and oncology practices. Results: Primary Care (n=7) and Oncology Practices (n=4): Interviews with primary care physicians, medical oncologists, advanced practice providers, nurses, tumor registrar, outreach coordinator, and office management & staff. Conclusions: Rural primary care and oncology practices experienced barriers to delivering survivorship care including: educational gaps, communication of history, treatment, and recommendations, EHR integration, and lack of resources. Next steps focus on a unified approach to state-wide survivorship education of patients, primary care and oncology practices. [Table: see text]


2021 ◽  
Author(s):  
Daniel E. Jonas ◽  
Colleen Barclay ◽  
Debbie Grammer ◽  
Chris Weathington ◽  
Sarah A. Birken ◽  
...  

Abstract Background: Unhealthy alcohol use is a leading cause of preventable deaths in the US and is associated with many societal and health problems. Less than a third of people who visit primary care providers in the US are asked about or ever discuss alcohol use with a health professional. Methods/design: This study is an adaptive, randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in small-to-medium-sized primary care practices. Study participants will include primary care practices in North Carolina with 10 or fewer providers. All enrolled practices will receive a practice facilitation intervention that includes quality improvement (QI) coaching, electronic health record (EHR) support, training, and expert consultation. After 6 months, practices in the lower 50th percentile (based on performance) will be randomized to continued practice facilitation or provision of telehealth services plus ongoing facilitation for the next 6 months. Practices in the upper 50th percentile after the initial 6 months of intervention will continue to receive practice facilitation alone. The main outcome measures include the number (and %) of patients in the target population who are screened for unhealthy alcohol use, screen positive, and receive brief counseling. Additional measures include the number (and %) of patients who receive pharmacotherapy for AUD or are referred for AUD services.Discussion: A successful intervention would significantly reduce morbidity among adults from unhealthy alcohol use by increasing counseling and other treatment opportunities. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. It will also generate scientific knowledge about whether embedded telehealth services can improve use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.Trial registration: ClinicalTrials.gov NCT04317989. March 23, 2020 –registered, https://www.clinicaltrials.gov/ct2/show/NCT04317989?titles=STUN&draw=2&rank=1


Medical Care ◽  
2008 ◽  
Vol 46 (Supplement 1) ◽  
pp. S68-S73 ◽  
Author(s):  
Donald E. Nease ◽  
Mack T. Ruffin ◽  
Michael S. Klinkman ◽  
Masahito Jimbo ◽  
Thomas M. Braun ◽  
...  

1999 ◽  
Vol 18 (5) ◽  
pp. 89-105 ◽  
Author(s):  
Lisa V. Rubenstein ◽  
Maga Jackson-Triche ◽  
Jürgen Unützer ◽  
Jeanne Miranda ◽  
Katy Minnium ◽  
...  

2013 ◽  
Vol 173 (17) ◽  
pp. 1584 ◽  
Author(s):  
Thomas G. McGinn ◽  
Lauren McCullagh ◽  
Joseph Kannry ◽  
Megan Knaus ◽  
Anastasia Sofianou ◽  
...  

10.2196/18977 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e18977
Author(s):  
Robin M Dawson ◽  
Sue P Heiney ◽  
DeAnne Hilfinger Messias ◽  
Dennis Ownby

Background Rural Latino children with asthma suffer high rates of uncontrolled asthma symptoms, emergency department visits, and repeat hospitalizations. This vulnerable population must negotiate micro- and macrolevel challenges that impact asthma management, including language barriers, primary care access, parental time off from work, insurance coverage, distance from specialty sites, and documentation status. There are few proven interventions that address asthma management embedded within this unique context. Objective Using a bio-ecological approach, we will determine the feasibility of a patient-centered collaborative program between rural Latino children with asthma and their families, school-based nursing programs, and primary care providers, facilitated by the use of a smartphone-based mobile app with a Spanish-language interface. We hypothesize that improving communication through a collaborative, patient-centered intervention will improve asthma management, empower the patient and family, decrease outcome disparities, and decrease direct and indirect costs. Methods The specific aims of this study include the following: (1) Aim 1: produce and validate a Spanish translation of an existing asthma management app and evaluate its usability with Latino parents of children with asthma, (2) Aim 2: develop and evaluate a triadic, patient-centered asthma intervention preliminary protocol, facilitated by the bilingual mobile app validated in Aim 1, and (3) Aim 3: investigate the feasibility of the patient-centered asthma intervention from Aim 2 using a waiting-list randomized controlled trial (RCT) to investigate the effects of the intervention on school days missed and medication adherence. Results Mobile app translation, initial usability testing, and app software refinement were completed in 2019. Analysis is in progress. Preliminary protocol testing is underway; we anticipate that the waiting-list RCT, using the refined protocol developed in Aim 2, will commence in fall 2020. Conclusions Tailored, technology-based solutions have the potential to successfully address issues affecting asthma management, including communication barriers, accessibility issues, medication adherence, and suboptimal technological interventions. Trial Registration ClinicalTrials.gov NCT04633018; https://www.clinicaltrials.gov/ct2/show/NCT04633018 International Registered Report Identifier (IRRID) DERR1-10.2196/18977


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel E. Jonas ◽  
Colleen Barclay ◽  
Debbie Grammer ◽  
Chris Weathington ◽  
Sarah A. Birken ◽  
...  

Abstract Background Unhealthy alcohol use is a leading cause of preventable deaths in the USA and is associated with many societal and health problems. Less than a third of people who visit primary care providers in the USA are asked about or ever discuss alcohol use with a health professional. Methods/design This study is an adaptive, randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in small-to-medium-sized primary care practices. Study participants will include primary care practices in North Carolina with 10 or fewer providers. All enrolled practices will receive a practice facilitation intervention that includes quality improvement (QI) coaching, electronic health record (EHR) support, training, and expert consultation. After 6 months, practices in the lower 50th percentile (based on performance) will be randomized to continued practice facilitation or provision of telehealth services plus ongoing facilitation for the next 6 months. Practices in the upper 50th percentile after the initial 6 months of intervention will continue to receive practice facilitation alone. The main outcome measures include the number (and %) of patients in the target population who are screened for unhealthy alcohol use, screen positive, and receive brief counseling. Additional measures include the number (and %) of patients who receive pharmacotherapy for AUD or are referred for AUD services. Sample size calculations determined that 35 practices are needed to detect a 10% increase in the main outcome (percent screened for unhealthy alcohol use) over 6 months. Discussion A successful intervention would significantly reduce morbidity among adults from unhealthy alcohol use by increasing counseling and other treatment opportunities. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. It will also generate scientific knowledge about whether embedded telehealth services can improve the use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices. Trial registration ClinicalTrials.govNCT04317989. Registered on March 23, 2020.


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