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Miles LM, Ducharme FM, Collin J, Blais L, Bacon SL, Lavoie KL, McKinney ML, Peláez S. Physician's perspective regarding asthma guided self-management: directives or guidance? J Asthma 2021; 59:1263-1268. [PMID: 33877960 DOI: 10.1080/02770903.2021.1914652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma guided self-management enhances patients' control of their condition under the guidance of the treating physician. The aim of the present study was to understand how physicians perceive, endorse, uptake, and support asthma guided self-management. METHODS We conducted a secondary supplementary analysis of data originally collected as part of a multicenter collective case study in which physicians treating patients with asthma were interviewed. Using reflective thematic analysis, we aimed to explore physicians' understanding of guided asthma self-management as related to four ideas, namely: (a) understanding of the disease management and treatment goals; (b) defining medical frame and guidance; (c) describing the importance of patient-physician relationship; and (d) implementing asthma guided self-management. RESULTS Evidence indicates that physicians perceived optimal guided self-management as related to patients' adherence to physician's instructions and recommendations, supported by the adjustment of prescribed pharmaceutical therapy contingent upon patient's symptoms. Some physicians also perceived behavior change and environmental control along with the medical recommendations. While physicians' perception of asthma and its treatment were aligned with the recommended guidelines-i.e., patient-centered care approach based on guided self-management, the actual guidance offered to patients remained primarily directive and paternalistic. Non-pharmacological approaches, such as exercise, smoking cessation, patient self-monitoring, and self-management supported by education and written self-management plans, were given little consideration in the context of the recommended treatment plan.
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Affiliation(s)
- Laura May Miles
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Collin
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,School of Kinesiology and Physical Activity Sciences (EKSAP), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Majellano EC, Clark VL, Winter NA, Gibson PG, McDonald VM. Approaches to the assessment of severe asthma: barriers and strategies. J Asthma Allergy 2019; 12:235-251. [PMID: 31692528 PMCID: PMC6712210 DOI: 10.2147/jaa.s178927] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/25/2019] [Indexed: 12/12/2022] Open
Abstract
Asthma is a chronic condition with great variability. It is characterized by intermittent episodes of wheeze, cough, chest tightness, dyspnea and backed by variable airflow limitation, airway inflammation and airway hyper-responsiveness. Asthma severity varies uniquely between individuals and may change over time. Stratification of asthma severity is an integral part of asthma management linking appropriate treatment to establish asthma control. Precision assessment of severe asthma is crucial for monitoring the health of people with this disease. The literature suggests multiple factors that impede the assessment of severe asthma, these can be grouped into health care professional, patient and organizational related barriers. These barriers do not exist in isolation but interact and influence one another. Recognition of these barriers is necessary to promote precision in the assessment and management of severe asthma in the era of targeted therapy. In this review, we discuss the current knowledge of the barriers that impede assessment in severe asthma and recommend potential strategies for overcoming these barriers. We highlight the relevance of multidimensional assessment as an ideal approach to the assessment and management of severe asthma.
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Affiliation(s)
- Eleanor C Majellano
- Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa L Clark
- Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
| | - Natasha A Winter
- Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Patient Perceptions of Living with Severe Asthma: Challenges to Effective Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2613-2621.e1. [PMID: 31178414 DOI: 10.1016/j.jaip.2019.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of severe asthma poses many challenges related to treatment, adherence, and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma. OBJECTIVE To explore the patient perceptions of living with severe asthma and the experience of managing severe asthma, in order to better understand the support that might promote more effective self-management for severe asthma. METHODS Participants were recruited from a specialist Difficult Asthma Service. Semistructured interviews were conducted by researchers independent of the patient's care. Interviews were transcribed verbatim and inductive thematic analysis was performed. RESULTS Twenty-nine participants (13 male: mean [standard deviation] age, 49.5 [13.6] years: mean Asthma Control Questionnaire 2.2 [1.2]) participated in an interview. Analysis resulted in 4 major themes describing the experience and challenges to managing severe asthma: understanding of severe asthma, emotional impact of living with severe asthma (subtheme: fear of hospitalization), public perceptions of asthma, and concerns about medications. CONCLUSIONS Health care professionals need to consider and discuss with patients their perceptions of severe asthma and the relevant treatments; particular attention should focus around education of disease control and actively exploring thoughts around hospitalization. Our data highlight the potential for psychological and social support to enhance self-management by directly addressing the wide-ranging individual challenges patients face. There is also a need for greater public awareness and education about severe asthma to minimize patient distress particularly in the work environment.
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Price C, Agarwal G, Chan D, Goel S, Kaplan AG, Boulet LP, Mamdani MM, Straus SE, Lebovic G, Gupta S. Large care gaps in primary care management of asthma: a longitudinal practice audit. BMJ Open 2019; 9:e022506. [PMID: 30696669 PMCID: PMC6352804 DOI: 10.1136/bmjopen-2018-022506] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Care gaps in asthma may be highly prevalent but are poorly characterised. We sought to prospectively measure adherence to key evidence-based adult asthma practices in primary care, and predictors of these behaviours. DESIGN One-year prospective cohort study employing an electronic chart audit. SETTING Three family health teams (two academic, one community-based) in Ontario, Canada. PARTICIPANTS 884 patients (72.1% female; 46.0±17.5 years old) (4199 total visits; 4.8±4.8 visits/patient) assigned to 23 physicians (65% female; practising for 10.0±8.6 years). MAIN OUTCOME MEASURES The primary outcome was the proportion of visits during which practitioners assessed asthma control according to symptom-based criteria. Secondary outcomes included the proportion of: patients who had asthma control assessed at least once; visits during which a controller medication was initiated or escalated; and patients who received a written asthma action plan. Behavioural predictors were established a priori and tested in a multivariable model. RESULTS Primary outcome: Providers assessed asthma control in 4.9% of visits and 15.4% of patients. Factors influencing assessment included clinic site (p=0.019) and presenting symptom, with providers assessing control more often during visits for asthma symptoms (35.0%) or any respiratory symptoms (18.8%) relative to other visits (1.6%) (p<0.01). SECONDARY OUTCOMES Providers escalated controller therapy in 3.3% of visits and 15.4% of patients. Factors influencing escalation included clinic site, presenting symptom and prior objective asthma diagnosis. Escalation occurred more frequently during visits for asthma symptoms (21.0%) or any respiratory symptoms (11.9%) relative to other visits (1.5%) (p<0.01) and in patients without a prior objective asthma diagnosis (3.5%) relative to those with (1.3%) (p=0.025). No asthma action plans were delivered. CONCLUSIONS Major gaps in evidence-based asthma practice exist in primary care. Targeted knowledge translation interventions are required to address these gaps, and can be tailored by leveraging the identified behavioural predictors. TRIAL REGISTRATION NUMBER NCT01070095; Pre-results.
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Affiliation(s)
- Courtney Price
- The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Chan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sanjeev Goel
- Health Quality Innovation Collaborative, Brampton, Ontario, Canada
| | - Alan G Kaplan
- Family Physician Airways Group of Canada, Edmonton, Alberta, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Montreal, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART) Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gerald Lebovic
- The Applied Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samir Gupta
- The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Farnesi BC, Ducharme FM, Blais L, Collin J, Lavoie KL, Bacon SL, McKinney ML, Peláez S. Guided asthma self-management or patient self-adjustment? Using patients' narratives to better understand adherence to asthma treatment. Patient Prefer Adherence 2019; 13:587-597. [PMID: 31114172 PMCID: PMC6485321 DOI: 10.2147/ppa.s195585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The purpose of this study was to better understand patients' perspective of asthma self-management by focusing on the sociocultural and medical context shaping patients' illness representations and individual decisions. PATIENTS AND METHODS We conducted a secondary analysis of semi-structured interviews carried out as part of a multicentered collective qualitative case study. In total, 24 patients, aged 2-76 years with a confirmed diagnosis of asthma (or were parents of a child), who renewed the prescription for inhaled corticosteroids in the past year, participated in this study. The thematic analysis focused on asthma-related events and experiences reported by the patients. Consistent with narrative inquiry, similar patterns were grouped together, and three vignettes representing the different realities experienced by the patients were created. RESULTS The comparison of experiences and events reported by the patients suggested that patients' perceptions and beliefs regarding asthma and treatment goals influenced their self-management-related behaviors. More specifically, the medical context in which the patients were followed (ie, frame in which the medical encounter takes place, medical recommendations provided) contributed to shape their understanding of the disease and the associated treatment goals. In turn, a patient's perception of the disease and the treatment goals influenced asthma self-management behaviors related to environmental control, lifestyle habits, and medication intake. CONCLUSION Current medical recommendations regarding asthma self-management highlight the importance of the physicians' guidance through the provision of a detailed written action plan and asthma education. These data suggest that while physicians contribute to shaping patients' beliefs and perceptions about the disease and treatment goals, patients tend to listen to their own experience and manage the disease accordingly. Thus, a medical encounter between the patient and the physician, aiming at enhancing a meaningful conversation about the disease, may lead the patient to approach the disease in a more effective manner, which goes beyond taking preventative paths to avoid symptoms.
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Affiliation(s)
- Biagina-Carla Farnesi
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
| | - Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Sciences, University of Montreal, Montreal, QC Canada
- Research Centre, CHU Sainte-Justine, University of Montreal, Montreal, QC Canada,
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
| | - Johanne Collin
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
| | - Kim L Lavoie
- Psychology Department, University of Quebec at Montreal, Montreal, QC Canada
- Research Center, Sacré-Coeur de Montréal Hospital, CIUSSS du Nord-de-l'Ile-de-Montréal, Montreal, QC Canada
| | - Simon L Bacon
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
- Research Center, Sacré-Coeur de Montréal Hospital, CIUSSS du Nord-de-l'Ile-de-Montréal, Montreal, QC Canada
| | | | - Sandra Peláez
- Research Centre, CHU Sainte-Justine, University of Montreal, Montreal, QC Canada,
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada,
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McCleary N, Andrews A, Buelo A, Captieux M, Morrow S, Wiener-Ogilvie S, Fletcher M, Steed L, Taylor SJC, Pinnock H. IMP 2ART systematic review of education for healthcare professionals implementing supported self-management for asthma. NPJ Prim Care Respir Med 2018; 28:42. [PMID: 30401831 PMCID: PMC6219611 DOI: 10.1038/s41533-018-0108-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022] Open
Abstract
Despite a robust evidence base for its effectiveness, implementation of supported self-management for asthma is suboptimal. Professional education is an implementation strategy with proven effectiveness, though the specific features linked with effectiveness are often unclear. We performed a systematic review of randomised controlled trials and controlled clinical trials (published from 1990 and updated to May 2017 using forward citation searching) to determine the effectiveness of professional education on asthma self-management support and identify features of effective initiatives. Primary outcomes reflected professional behaviour change (provision of asthma action plans) and patient outcomes (asthma control; unscheduled care). Data were coded using the Effective Practice and Organisation of Care Taxonomy, the Theoretical Domains Framework (TDF), and Bloom's Taxonomy and synthesised narratively. Of 15,637 articles identified, 18 (reporting 15 studies including 21 educational initiatives) met inclusion criteria. Risk of bias was high for five studies, and unclear for 10. Three of 6 initiatives improved action plan provision; 1/2 improved asthma control; and 2/7 reduced unscheduled care. Compared to ineffective initiatives, effective initiatives were more often coded as being guideline-based; involving local opinion leaders; including inter-professional education; and addressing the TDF domains 'social influences'; 'environmental context and resources'; 'behavioural regulation'; 'beliefs about consequences'; and 'social/professional role and identity'. Findings should be interpreted cautiously as many strategies were specified infrequently. However, identified features warrant further investigation as part of implementation strategies aiming to improve the provision of supported self-management for asthma.
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Affiliation(s)
- Nicola McCleary
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mireille Captieux
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Susan Morrow
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Monica Fletcher
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
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7
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Yamada J, Potestio ML, Cave AJ, Sharpe H, Johnson DW, Patey AM, Presseau J, Grimshaw JM. Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings. J Asthma 2017; 55:1223-1236. [PMID: 29261346 DOI: 10.1080/02770903.2017.1408820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to apply a theory-based approach to identify barriers and enablers to implementing the Alberta Primary Care Asthma Pediatric Pathway (PCAPP) into clinical practice. Phase 1 included an assessment of assumptions underlying the intervention from the perspectives of the developers. Phase 2 determined the perceived barriers and enablers for: 1) primary care physicians' prescribing practices, 2) allied health care professionals' provision of asthma education to parents, and 3) children and parents' adherence to their treatment plans. METHODS Interviews were conducted with 35 individuals who reside in Alberta, Canada. Phase 1 included three developers. Phase 2 included 11 primary care physicians, 10 allied health care professionals, and 11 parents of children with asthma. Phase 2 interviews were based on the 14 domains of the Theoretical Domains Framework (TDF). Transcribed interviews were analyzed using a directed content analysis. Key assumptions by the developers about the intervention, and beliefs by others about the barriers and enablers of the targeted behaviors were identified. RESULTS Eight TDF domains mapped onto the assumptions of the pathway as described by the intervention developers. Interviews with health care professionals and parents identified nine TDF domains that influenced the targeted behaviors: knowledge, skills, beliefs about capabilities, social/professional role and identity, beliefs about consequences, environmental context and resources, behavioral regulation, social influences, and emotions. CONCLUSIONS Barriers and enablers perceived by health care professionals and parents that influenced asthma management will inform the optimization of the PCAPP prior to its evaluation.
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Affiliation(s)
- Janet Yamada
- a Faculty of Community Services, Daphne Cockwell School of Nursing , Ryerson University , Toronto , Ontario , Canada
| | - Melissa L Potestio
- b Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
| | - Andrew J Cave
- c Department of Family Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Heather Sharpe
- d Respiratory Health Strategic Clinical Network, Alberta Health Services , Calgary , Alberta , Canada
| | - David W Johnson
- e Department of Pediatrics , Emergency Medicine, Physiology and Pharmacology, Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
| | - Andrea M Patey
- f Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Justin Presseau
- g School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Jeremy M Grimshaw
- h Department of Medicine , University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
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Djandji F, Lamontagne AJ, Blais L, Bacon SL, Ernst P, Grad R, Lavoie KL, McKinney ML, Desplats E, Ducharme FM. Enablers and determinants of the provision of written action plans to patients with asthma: a stratified survey of Canadian physicians. NPJ Prim Care Respir Med 2017; 27:21. [PMID: 28364118 PMCID: PMC5434790 DOI: 10.1038/s41533-017-0012-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 11/09/2022] Open
Abstract
Despite national recommendations, most patients with asthma are not given a written action plan . The objectives were to ascertain physicians' endorsement of potential enablers to providing a written action plan, and the determinants and proportion, of physician-reported use of a written action plan. We surveyed 838 family physicians, paediatricians, and emergency physicians in Quebec. The mailed questionnaire comprised 102 questions on asthma management, 11 of which pertained to written action plan and promising enablers. Physicians also selected a case vignette that best corresponded to their practice and reported their management. The survey was completed by 421 (56%) physicians (250 family physicians, 115 paediatricians and 56 emergency physicians); 43 (5.2%) reported providing a written action plan to ≥70% of their asthmatic patients and 126 (30%) would have used a written action plan in the selected vignette. Most (>60%) physicians highly endorsed the following enablers: patients requesting a written action plan, adding a blank written action plan to the chart, receiving a copy of the written action plan completed by a consultant, receiving a monetary compensation for its completion, and having another healthcare professional explain the completed written action plan to patients. Four determinants were significantly associated with providing a written action plan: being a paediatrician (RR:2.1), treating a child (RR:2.0), aiming for long-term asthma control (RR:2.5), and being aware of national recommendations to provide a written action plan to asthmatic patients (RR:2.9). A small minority of Quebec physicians reported providing a written action plan to most of their patients, revealing a huge care gap. Several enablers to improve uptake, highly endorsed by physicians, should be prioritised in future implementation efforts. ASTHMA ENCOURAGING DOCTORS TO PROVIDE WRITTEN ACTION PLANS: Changes to practice organization and doctors' perceptions should encourage the provision of written action plans for all asthma patients. International guidelines state that effective long-term treatment of asthma requires educated self-management, regular reviews and provision of a written action plan (WAP). However, many patients have poor asthma control and as few as 30 per cent have a WAP. Fabienne Djandji at the Saint-Justine University Central Hospital in Montreal, Canada, and co-workers conducted a survey of 421 doctors to determine their attitudes and provision of WAPs. Only 5.2 per cent of respondents provided WAPs to patients; those treating children or aiming for long-term asthma control were more likely to do so. The doctors said that incentives to provide WAPs would include requests from patients themselves, being paid to complete WAPs and having extra support from specialists or other health care professionals such as pharmacists.
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Affiliation(s)
- Fabienne Djandji
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
| | - Alexandrine J Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
- Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Clinical Epidemiology (MUHC) Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Eve Desplats
- Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.
- Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada.
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9
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Tilly-Gratton A, Lamontagne A, Blais L, Bacon SL, Ernst P, Grad R, Lavoie KL, McKinney ML, Desplats E, Ducharme FM. Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:335-342. [PMID: 27774739 DOI: 10.1111/ijpp.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma control remains suboptimal in Canada. Expansion of pharmacist's professional activities offers the opportunity to improve the interdisciplinary management of patients with asthma. OBJECTIVE The aim of this study was to determine the level of agreement of physicians regarding the expansion of pharmacists' professional activities in the management of asthma patients. METHODS We conducted a survey of randomly selected Quebec physicians in family medicine, paediatrics and emergency medicine. A 102-item questionnaire, including 10 questions regarding pharmacist's expanded professional activities, was sent using the Tailored Design Method. Questions were answered on a 6-point Likert-like scale (0 - strong disagreement to 5 - strong agreement). RESULTS With a 56% response rate, 421 (250 family medicine, 115 paediatric and 56 emergency medicine) physicians participated; the median years of practice (25%, 75%) was 13 (5-21) years and 69% of respondents were women. Physicians were in favour of the expansion of pharmacist's professional activities with strong endorsement rates (rating of ≥4 on a maximum of 5) exceeding 60% for all but three activities: suggesting a written action plan to the physician (55%), adjusting the dose of prescribed asthma medication to achieve a therapeutic target (52%) and offering spirometry testing in pharmacies (45%). Emergency physicians, physicians with fewer years of practice, and those with a favourable perception of an interprofessional approach were associated with higher endorsement of these activities. CONCLUSION Physicians are favourable to the expansion of pharmacist activities in the management of patients with asthma. More complex activities were less frequently endorsed. The characteristics of strong intenders have been identified.
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Affiliation(s)
- Audrey Tilly-Gratton
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Alexandrine Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, QC, Canada.,Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, QC, Canada.,Division of Clinical Epidemiology (MUHC) Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Eve Desplats
- Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
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Ducharme FM, Lamontagne AJ, Blais L, Grad R, Lavoie KL, Bacon SL, McKinney ML, Desplats E, Ernst P. Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma. Can Respir J 2016; 2016:4169010. [PMID: 27445537 PMCID: PMC4925971 DOI: 10.1155/2016/4169010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/10/2016] [Indexed: 11/18/2022] Open
Abstract
Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation.
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Affiliation(s)
- Francine M. Ducharme
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada H3T 1C5
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
- Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Alexandrine J. Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Lucie Blais
- Department of Pharmacology, University of Montreal, Montreal, QC, Canada H3T 1J4
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada H3T 1E2
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5
- Department of Psychology, Université du Québec à Montreal, Montreal, QC, Canada H3C 3P8
| | - Simon L. Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5
- Department of Exercise Science, Concordia University, Montreal, QC, Canada H4B 1R6
| | - Martha L. McKinney
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Eve Desplats
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Pierre Ernst
- Divisions of Clinical Epidemiology and of Pulmonary Medicine, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada H3T 1E2
- Department of Medicine, McGill University, Montreal, QC, Canada H4A 3J1
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Gupta S, Awasthi S. Assessment of treatment pattern of childhood asthma reporting to outpatients’ facility of a tertiary care hospital in Lucknow, North India: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Peláez S, Lamontagne AJ, Collin J, Gauthier A, Grad RM, Blais L, Lavoie KL, Bacon SL, Ernst P, Guay H, McKinney ML, Ducharme FM. Patients' perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy. BMC Pulm Med 2015; 15:42. [PMID: 25907709 PMCID: PMC4429418 DOI: 10.1186/s12890-015-0044-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients’ insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions. Methods We conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients’ perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach. Results Patients were aged 2–76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility. Conclusions We identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0044-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Alexandrine J Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Johanne Collin
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Annie Gauthier
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Roland M Grad
- Department of Family Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Lucie Blais
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Kim L Lavoie
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
| | - Simon L Bacon
- Department of Exercise Sciences, Concordia University, Montreal, Quebec, Canada.
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Hélène Guay
- Institut national d'excellence en santé et en services sociaux, Quebec, Quebec, Canada.
| | - Martha L McKinney
- Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada.
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. .,Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada. .,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. .,Departments of Pediatrics and of Social and Preventive Medicine, Associate Director of Clinical Research, Research Centre, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7939, Montreal, Quebec, H3T 1C5, Canada.
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Ernst P. Taking airway disease seriously. Thorax 2014; 69:307-8. [PMID: 24399629 DOI: 10.1136/thoraxjnl-2013-204709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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