Large care gaps in primary care management of asthma: a longitudinal practice audit

Price, Courtney; Agarwal, Gina; Chan, David W.; Goel, Sanjeev; Kaplan, Alan; Boulet, Louis‐Philippe; Mamdani, Muhammad; Straus, Sharon E.; Lebovic, Gerald; Gupta, Samir

doi:10.1136/bmjopen-2018-022506

Cited by 30 publications

(22 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Large gaps in knowledge exist in asthma care, management and diagnosis in primary care [ 31 ]. Physicians often do not take accurate or detailed workplace histories of their patients which would help identify the link between work exposures and asthma symptoms [ 5 , 25 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

MacKinnon

Ramsey

et al. 2020

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

Background: Work-related asthma (WRA) accounts for up to 25% of all adults with asthma. Early diagnosis is key for optimal management as delays in diagnosis are associated with worse outcomes. However, WRA is significantly underreported and the median time to diagnosis is 4 years. The objective of this review is to identify the gaps in awareness and reporting of WRA and identify gaps in current knowledge translation strategies for chronic disease in general, and asthma specifically. This will identify reasons for delays in WRA diagnosis, as well inform suggestions to improve knowledge translation strategies for dissemination and implementation of WRA prevention and management guidelines. Methods: Non-systematic literature reviews were conducted on PubMed with a focus on work-related asthma screening and diagnosis, and knowledge translation or translational medicine research in asthma and chronic disease. In total, 3571 titles and abstracts were reviewed with no restriction on date published. Of those, 207 were relevant and fully read. Another 37 articles were included and reviewed after citation reviews of articles from the initial search and from suggestions from editors. In total, 63 articles were included in the final review. Results: Patients, employers, and healthcare professionals lack awareness and under-report WRA which contribute to the delayed diagnosis of WRA, primarily through lack of education, stigma associated with WRA, and lack of awareness and screening in primary care. Knowledge translation strategies for asthma research typically involve the creation of guidelines for diagnosis of the disease, asthma care plans and tools for education and management. While there are some prevention programs in place for certain industries, gaps in knowledge translation strategies including lack of screening tools currently available for WRA, poor education of employers and physicians in identifying WRA, and education of patients is often done post-diagnosis and focuses on management rather than prevention or screening. Conclusion: Future knowledge translation strategies should focus on educating employees and employers well before potential exposure to agents associated with WRA and screening for WRA in primary care to enable health care providers to recognize and diagnose WRA.

show abstract

Section: Resultsmentioning

confidence: 99%

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

MacKinnon

Ramsey

et al. 2020

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

show abstract

“…All predictors are shown in Table 3 . Patient asthma control level was missing in 40% of visits (a known care gap [ 21 ]) and was therefore excluded from the model.…”

Section: Resultsmentioning

confidence: 99%

Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling

Kouri¹,

Yamada²,

Sale³

et al. 2020

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

Background mHealth tablet-based interventions are increasingly being studied and deployed in various health care settings, yet little knowledge exists regarding patient uptake and acceptance or how patient demographics influence these important implementation metrics. Objective To determine which factors influence the uptake and successful completion of an mHealth tablet questionnaire by analyzing its implementation in a primary care setting. Methods We prospectively studied a patient-facing electronic touch-tablet asthma questionnaire deployed as part of the Electronic Asthma Management System. We describe tablet uptake and completion rates and corresponding predictor models for these behaviors. Results The tablet was offered to and accepted by patients in 891/1715 (52.0%) visits. Patients refused the tablet in 33.0% (439/1330) visits in which it was successfully offered. Patients aged older than 65 years of age (odds ratio [OR] 2.30, 95% CI 1.33-3.95) and with concurrent chronic obstructive pulmonary disease (OR 2.22, 95% CI 1.05-4.67) were more likely to refuse the tablet, and those on an asthma medication (OR 0.55, 95% CI 0.30-0.99) were less likely to refuse it. Once accepted, the questionnaire was completed in 784/891 (88.0%) instances, with those on an asthma medication (OR 0.53, 95% CI 0.32-0.88) being less likely to leave it incomplete. Conclusions Older age predicted initial tablet refusal but not tablet questionnaire completion, suggesting that perceptions of mHealth among older adults may negatively impact uptake, independent of usability. The influence of being on an asthma medication suggests that disease severity may also mediate mHealth acceptance. Although use of mHealth questionnaires is growing rapidly across health care settings and diseases, few studies describe their real-world acceptance and its predictors. Our results should be complemented by qualitative methods to identify barriers and enablers to uptake and may inform technological and implementation strategies to drive successful usage.

show abstract

“…Asthma affects approximately 7.7% of adults in the United States and carries an annual economic burden exceeding US $50 billion [ 1 , 2 ]. As in many other common chronic diseases, large gaps between guideline-recommended care and real-world care continue to exist in asthma [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Our team developed the Electronic Asthma Management System (eAMS), a point-of-care CDSS, to bridge key care gaps in the management of asthma in primary care settings [ 5 ]. The eAMS consists of a previsit electronic patient questionnaire that collects asthma-related parameters and a CDSS that receives and processes questionnaire data to produce guideline-based decision support (asthma control level, corresponding medication change recommendations, and a self-management tool called an asthma action plan (AAP) [ 4 ] integrated into the EHR in real time). In a 2-year interrupted time series study involving 890 patients and 237 clinicians, the eAMS significantly improved the frequency of asthma control assessment, the ratio of controller to reliever medication prescriptions, and delivery of AAPs to patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and Enablers to Using a Patient-Facing Electronic Questionnaire: A Qualitative Theoretical Domains Framework Analysis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Electronic patient questionnaires are becoming ubiquitous in health care. To address care gaps that contribute to poor asthma management, we developed the Electronic Asthma Management System, which includes a previsit electronic patient questionnaire linked to a computerized clinical decision support system. Objective This study aims to identify the determinants (barriers and enablers) of patient uptake and completion of a previsit mobile health questionnaire. Methods We conducted semistructured interviews with adult patients with asthma in Toronto, Canada. After demonstrating the questionnaire, participants completed the questionnaire using their smartphones and were then interviewed regarding perceived barriers and enablers to using and completing the questionnaire. Interview questions were based on the Theoretical Domains Framework to identify the determinants of health-related behavior. We generated themes that addressed the enablers and barriers to the uptake and completion of the questionnaire. Results In total, 12 participants were interviewed for saturation. Key enablers were as follows: the questionnaire was easy to complete without additional knowledge or skills and was perceived as a priority and responsibility for patients, use could lead to more efficient and personalized care, completion on one’s own time would be convenient, and uptake and completion could be optimized through patient reminders. Concerns about data security, the usefulness of questionnaire data, the stress of completing it accurately and on time, competing priorities, and preferences to complete the questionnaire on other devices were the main barriers. Conclusions The barriers and enablers identified by patients should be addressed by developing implementation strategies to enhance e-questionnaire use and completion by patients. As the use of e-questionnaires grows, our findings will contribute to implementation efforts across settings and diseases.

show abstract

Large care gaps in primary care management of asthma: a longitudinal practice audit

Cited by 30 publications

References 45 publications

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling

Barriers and Enablers to Using a Patient-Facing Electronic Questionnaire: A Qualitative Theoretical Domains Framework Analysis

Contact Info

Product

Resources

About