1
|
Pagano L, McKeough Z, Wootton SL, Chan ASL, Mahadev S, Zwar N, Pallavicini D, Dennis S. Acceptability and barriers of a GP-physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study. Health Expect 2023; 27:e13935. [PMID: 38063819 PMCID: PMC10757211 DOI: 10.1111/hex.13935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/24/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)-physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model. METHODS Semi-structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp-physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews. RESULTS All clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence-based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self-management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers. CONCLUSIONS An experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation. PATIENT OR PUBLIC CONTRIBUTION Patient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients. TRIAL REGISTRATION ACTRN12619001127190.
Collapse
Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Present address:
Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Sally L. Wootton
- Sydney School of Health Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Chronic Disease Community Rehabilitation ServiceNorthern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Andrew S. L. Chan
- Department of Respiratory and Sleep MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Sriram Mahadev
- Department of Respiratory and Sleep MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Nicholas Zwar
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | | | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Ingham Institute for Applied Medical ResearchSydneyNew South WalesAustralia
- South Western Sydney Local Health DistrictLiverpoolNew South WalesAustralia
| |
Collapse
|
2
|
Gleeson PK, Morales KH, Buckey TM, Fadugba OO, Apter AJ, Christie JD, Himes BE. Factors associated with aeroallergen testing among adults with asthma in a large health system. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100167. [PMID: 37841071 PMCID: PMC10570953 DOI: 10.1016/j.jacig.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023]
Abstract
Background Aeroallergen testing informs precision care for adults with asthma, yet the epidemiology of testing in this population remains poorly understood. Objective We sought to identify factors associated with receiving aeroallergen testing, the results of these tests, and subsequent reductions in exacerbation measures among adults with asthma. Methods We used electronic health record data to conduct a retrospective, observational cohort study of 30,775 adults with asthma who had an office visit with a primary care provider or an asthma specialist from January 1, 2017, to August 26, 2022. We used regression models to identify (1) factors associated with receiving any aeroallergen test and tests to 9 allergen categories after the index visit, (2) factors associated with positive test results, and (3) reductions in asthma exacerbation measures in the year after testing compared with before testing. Results Testing was received by 2201 patients (7.2%). According to multivariable models, receiving testing was associated with having any office visit with an allergy/immunology specialist during the study period (odds ratio [OR] = 91.3 vs primary care only [P < .001]) and having an asthma emergency department visit (OR = 1.62 [P = .004]) or hospitalization (OR = 1.62 [P = .03]) in the year before the index visit. Age 65 years or older conferred decreased odds of testing (OR = 0.74 vs age 18-34 years [P = .008]) and negative test results to 6 categories (P ≤ .04 for all comparisons). Black race conferred increased odds of testing (OR =1.22 vs White race [P = .01]) and positive test results to 8 categories (P < .04 for all comparisons). Exacerbation measures decreased after testing. Conclusion Aeroallergen testing was performed infrequently among adults with asthma and was associated with reductions in asthma exacerbation measures.
Collapse
Affiliation(s)
- Patrick K. Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Timothy M. Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Olajumoke O. Fadugba
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Andrea J. Apter
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jason D. Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Blanca E. Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
3
|
Figueira-Gonçalves JM, de Miguel-Díez J, Molina París J, Valero Pérez JM, Fernández-Villar A. Is it Reasonable to Start Bronchodilator Treatment Before Confirming the Diagnosis of COPD? OPEN RESPIRATORY ARCHIVES 2023; 5:100281. [PMID: 38024202 PMCID: PMC10661183 DOI: 10.1016/j.opresp.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Respiratory Department, Research Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain
- Canary Tropical Disease and Public Health Institute, La Laguna University, La Laguna, Spain
| | - Javier de Miguel-Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Molina París
- Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, Spain
| | | | - Alberto Fernández-Villar
- Department of Pneumology, Alvaro Cunqueiro University Teaching Hospital, NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur – IISGS), Vigo, Spain
| |
Collapse
|
4
|
Gagné M, Karanikas A, Green S, Gupta S. Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis. BMJ Open Respir Res 2023; 10:e001716. [PMID: 37730281 PMCID: PMC10510936 DOI: 10.1136/bmjresp-2023-001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Climate change from greenhouse gas (GHG) emissions represents one of the greatest public health threats of our time. Inhalers (and particularly metred-dose inhalers (MDIs)) used for asthma and chronic obstructive pulmonary disease (COPD), constitute an important source of GHGs. In this analysis, we aimed to estimate the carbon footprint impact of improving three distinct aspects of respiratory care that drive avoidable inhaler use in Canada. METHODS We used published data to estimate the prevalence of misdiagnosed disease, existing inhaler use patterns, medication class distributions, inhaler type distributions and GHGs associated with inhaler actuations, to quantify annual GHG emissions in Canada: (1) attributable to asthma and COPD misdiagnosis; (2) attributable to overuse of rescue inhalers due to suboptimally controlled symptoms; and (3) avoidable by switching 25% of patients with existing asthma and COPD to an otherwise comparable therapeutic option with a lower GHG footprint. RESULTS We identified the following avoidable annual GHG emissions: (1) ~49 100 GHG metric tons (MTs) due to misdiagnosed disease; (2) ~143 000 GHG MTs due to suboptimal symptom control; and (3) ~262 100 GHG MTs due to preferential prescription of strategies featuring MDIs over lower-GHG-emitting options (when 25% of patients are switched to lower GHG alternatives). Combined, the GHG emission reductions from bridging these gaps would be the equivalent to taking ~101 100 vehicles off the roads each year. CONCLUSIONS Our analysis shows that the carbon savings from addressing misdiagnosis and suboptimal disease control are comparable to those achievable by switching one in four patients to lower GHG-emitting therapeutic strategies. Behaviour change strategies required to achieve and sustain delivery of evidence-based real-world care are complex, but the added identified incentive of carbon footprint reduction may in itself prove to be a powerful motivator for change among providers and patients. This additional benefit can be leveraged in future behaviour change interventions.
Collapse
Affiliation(s)
- Myriam Gagné
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Aliki Karanikas
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Samantha Green
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir Gupta
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Gupta S, Thériault G. Do not diagnose or routinely treat asthma or chronic obstructive pulmonary disease without pulmonary function testing. BMJ 2023; 380:e072834. [PMID: 36940980 DOI: 10.1136/bmj-2022-072834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Samir Gupta
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Canada
| | | |
Collapse
|
6
|
Moloney M, MacKinnon M, Bullock E, Morra A, Barber D, Gupta S, Queenan JA, Digby GC, To T, Lougheed MD. Integrating User Preferences for Asthma Tools and Clinical Guidelines Into Primary Care Electronic Medical Records: Mixed Methods Study. JMIR Form Res 2023; 7:e42767. [PMID: 36809175 PMCID: PMC9993230 DOI: 10.2196/42767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Asthma is a chronic respiratory disease that poses a substantial burden on individuals and the health care system. Despite published national guidelines for the diagnosis and management of asthma, considerable care gaps exist. Suboptimal adherence to asthma diagnosis and management guidelines contributes to poor patient outcomes. The integration of electronic tools (eTools) into electronic medical records (EMRs) represents a knowledge translation opportunity to support best practices. OBJECTIVE The purpose of this study was to determine how best to integrate evidence-based asthma eTools into primary care EMRs across Ontario and Canada to improve adherence to guidelines as well as measure and monitor performance. METHODS In total, 2 focus groups comprising physicians and allied health professionals who were considered experts in primary care, asthma, and EMRs were convened. One focus group also included a patient participant. Focus groups used a semistructured discussion-based format to consider the optimal methods for integrating asthma eTools into EMRs. Discussions were held on the web via Microsoft Teams (Microsoft Corp). The first focus group discussed integrating asthma indicators into EMRs using eTools, and participants completed a questionnaire evaluating the clarity, relevance, and feasibility of collecting asthma performance indicator data at the point of care. The second focus group addressed how to incorporate eTools for asthma into a primary care setting and included a questionnaire evaluating the perceived utility of various eTools. Focus group discussions were recorded and analyzed using thematic qualitative analysis. The responses to focus group questionnaires were assessed using descriptive quantitative analysis. RESULTS Qualitative analysis of the 2 focus group discussions revealed 7 key themes: designing outcome-oriented tools, gaining stakeholder trust, facilitating open lines of communication, prioritizing the end user, striving for efficiency, ensuring adaptability, and developing within existing workflows. In addition, 24 asthma indicators were rated according to clarity, relevance, feasibility, and overall usefulness. In total, 5 asthma performance indicators were identified as the most relevant. These included smoking cessation support, monitoring using objective measures, the number of emergency department visits and hospitalizations, assessment of asthma control, and presence of an asthma action plan. The eTool questionnaire responses revealed that the Asthma Action Plan Wizard and Electronic Asthma Quality of Life Questionnaire were perceived to be the most useful in primary care. CONCLUSIONS Primary care physicians, allied health professionals, and patients consider that eTools for asthma care present a unique opportunity to improve adherence to best-practice guidelines in primary care and collect performance indicators. The strategies and themes identified in this study can be leveraged to overcome barriers associated with asthma eTool integration into primary care EMRs. The most beneficial indicators and eTools, along with the key themes identified, will guide future asthma eTool implementation.
Collapse
Affiliation(s)
- Max Moloney
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada.,Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Madison MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emma Bullock
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada.,Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Alison Morra
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada.,Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Barber
- Canadian Primary Care Sentinel Surveillance Network, Kingston, ON, Canada.,Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Samir Gupta
- Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John A Queenan
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Geneviève C Digby
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Science, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada.,Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
7
|
Cherian M, Magner KMA, Whitmore GA, Vandemheen KL, FitzGerald JM, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed MD, Licskai CJ, Azher T, Ainslie M, Ezer N, Mulpuru S, Aaron SD. Patient and physician factors associated with symptomatic undiagnosed asthma or COPD. Eur Respir J 2023; 61:13993003.01721-2022. [PMID: 36328359 DOI: 10.1183/13993003.01721-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND It remains unclear why some symptomatic individuals with asthma or COPD remain undiagnosed. Here, we compare patient and physician characteristics between symptomatic individuals with obstructive lung disease (OLD) who are undiagnosed and individuals with physician-diagnosed OLD. METHODS Using random-digit dialling and population-based case finding, we recruited 451 participants with symptomatic undiagnosed OLD and 205 symptomatic control participants with physician-diagnosed OLD. Data on symptoms, quality of life and healthcare utilisation were analysed. We surveyed family physicians of participants in both groups to elucidate differences in physician practices that could contribute to undiagnosed OLD. RESULTS Participants with undiagnosed OLD had lower mean pre-bronchodilator forced expiratory volume in 1 s percentage predicted compared with those who were diagnosed (75.2% versus 80.8%; OR 0.975, 95% CI 0.963-0.987). They reported greater psychosocial impacts due to symptoms and worse energy and fatigue than those with diagnosed OLD. Undiagnosed OLD was more common in participants whose family physicians were practising for >15 years and in those whose physicians reported that they were likely to prescribe respiratory medications without doing spirometry. Undiagnosed OLD was more common among participants who had never undergone spirometry (OR 10.83, 95% CI 6.18-18.98) or who were never referred to a specialist (OR 5.92, 95% CI 3.58-9.77). Undiagnosed OLD was less common among participants who had required emergency department care (OR 0.44, 95% CI 0.20-0.97). CONCLUSIONS Individuals with symptomatic undiagnosed OLD have worse pre-bronchodilator lung function and present with greater psychosocial impacts on quality of life compared with their diagnosed counterparts. They were less likely to have received appropriate investigations and specialist referral for their respiratory symptoms.
Collapse
Affiliation(s)
- Mathew Cherian
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kate M A Magner
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Deceased
| | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Andreanne Cote
- Centre de Recherche, Hôpital Laval, Université Laval, Quebec City, QC, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Catherine Lemière
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St John's, NL, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
8
|
Moloney M, Digby G, MacKinnon M, Morra A, Barber D, Queenan J, Gupta S, To T, Lougheed MD. Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement. Allergy Asthma Clin Immunol 2023; 19:3. [PMID: 36650578 PMCID: PMC9843861 DOI: 10.1186/s13223-022-00755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. METHODS Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. RESULTS Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. CONCLUSION Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.
Collapse
Affiliation(s)
- Max Moloney
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Geneviève Digby
- grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Madison MacKinnon
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Alison Morra
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - David Barber
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada ,Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON Canada
| | - John Queenan
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada
| | - Samir Gupta
- grid.415502.7Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Teresa To
- grid.42327.300000 0004 0473 9646Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| |
Collapse
|
9
|
Wang J, Wang L, Tian X, Luo L. N 6-methyladenosine reader YTHDF1 regulates the proliferation and migration of airway smooth muscle cells through m 6A/cyclin D1 in asthma. PeerJ 2023; 11:e14951. [PMID: 36992945 PMCID: PMC10042154 DOI: 10.7717/peerj.14951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Asthma is a chronic inflammatory respiratory disease, which is involved in multiple pathologic molecular mechanisms and presents a huge challenge to clinic nursing. Emerging evidence suggests that N6-methyladenosine (m6A) plays critical roles in respiratory system disease. Thus, present work tried to investigate the functions of m6A reader YTHDF 1 in asthma. The results indicated that YTHDF1 significantly upregulated in platelet-derived growth factor (PDGF) induced airway smooth muscle cells (ASMCs). Functionally, overexpression of YTHDF1 promoted the proliferation and migration of ASMCs, while YTHDF1 knockdown repressed the proliferation and migration. Mechanistically, there was a m6A modification site on cyclin D1 RNA (CCND1 genome) and YTHDF1 combined with cyclin D1 mRNA, thereby enhancing its mRNA stability via m6A-dependent manner. Collectively, these findings reveal a novel axis of YTHDF1/m6A/cyclin D1 in asthma's airway remodeling, which may provide novel therapeutic strategy for asthma.
Collapse
Affiliation(s)
- Juan Wang
- Department of Nursing, Fenyang Colleage of Shanxi Medical University, Fenyang, China
| | - Lei Wang
- College of Nursing, Shanxi Medical University, Taiyuan, China
| | - Xingfeng Tian
- Department of Student Affairs, Fenyang Colleage of Shanxi Medical University, Fenyang, China
| | - Lingping Luo
- Department of Nursing, Fenyang Colleage of Shanxi Medical University, Fenyang, China
| |
Collapse
|
10
|
Pagano L, Dennis S, Wootton S, Mahadev S, Chan ASL, Zwar N, Pallavicini D, McKeough Z. Identifying airway obstruction in primary care: is there a role for physiotherapists? BMC PRIMARY CARE 2022; 23:324. [PMCID: PMC9748384 DOI: 10.1186/s12875-022-01944-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Aims
To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.
Methods
Four general practices were recruited. ‘At risk’ participants (aged ≥ 40 years, current/ex-smoker) and people with ‘existing’ COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV1/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.
Results
One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 ‘at risk’, 31’existing’ COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of ‘at risk’ and 77% (24/31) of ‘existing’ COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV1 were classified as A (68%), B (19%) and C (5%).
Conclusion
Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding ‘at risk’ patients and identifying potential misdiagnosis of obstruction in some ‘existing’ COPD cases.
Trial registration
ANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx
Collapse
|
11
|
Yawn BP. Developing and Disseminating Evidence to Support Enhanced Spirometry Use in Primary Care Diagnosis of Asthma and COPD. Chest 2022; 161:865-866. [DOI: 10.1016/j.chest.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 10/18/2022] Open
|