Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices

Welch, Madelyn; Ludden, Thomas M.; Mottus, Kathleen; Bray, Paul; Hendrickson, Lori; Rees, Jennifer; Halladay, Jacqueline R.; Tapp, Hazel

doi:10.1080/02770903.2018.1471703

Cited by 6 publications

(3 citation statements)

References 47 publications

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“…A paper version of Coach McLungs SM was rigorously evaluated in previous studies [ 6 , 61 , 64 ]. This SDM intervention was associated with improved outcomes for both pediatrics and adults, such as reduced ED visits, hospitalizations, decreased rescue medication use, better adherence to asthma control medications, improved asthma-related quality of life, fewer asthma-related medical visits, better lung function, and improved perceptions of SDM [ 6 , 61 , 63 , 64 , 78 ]. The newly developed virtual version of Coach McLungs SM SDM intervention is currently being evaluated in two pediatric EDs within separate healthcare systems [ 79 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design

Ludden

O’Hare

Shade

et al. 2022

BMC Med Inform Decis Mak

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Background Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. One promising approach to addressing disparities is shared decision making (SDM), a method by which the patient and provider cooperatively make a decision about asthma care. SDM is associated with improved outcomes for patients; however, time constraints and staff availability are noted implementation barriers. Use of health information technology (IT) solutions may facilitate the utilization of SDM. Coach McLungsSM is a collaborative web-based application that involves pediatric patients, their caregivers, and providers in a personalized experience while gathering patient-reported data. Background logic provides decision support so both audiences can develop a well-informed treatment plan together. The goal of this study is to evaluate the implementation of the Coach McLungsSM intervention into primary care. Methods Implementation will be evaluated using a stepped wedge randomized control study design at 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. We will use a generalized linear mixed models with logit link to test the hypothesis for the reduction in exacerbation rates specifying the fixed effects of intervention and time and random effects for practice and practice*time. This design achieves 84% power to detect the hypothesized effect size difference of 10% in overall exacerbation between control (40%) and intervention (30%) periods (two-sided, p = 0.05). Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance). Discussion We anticipate that a tailored implementation of Coach McLungsSM across diverse primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control condition. Trial Registration: Clincaltrials.gov, NCT05059210. Registered 28 September 2021, https://www.clinicaltrials.gov/ct2/show/NCT05059210

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Section: Introductionmentioning

confidence: 99%

Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design

Ludden

O’Hare

Shade

et al. 2022

BMC Med Inform Decis Mak

Self Cite

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“…Here we describe a qualitative analysis of dissemination of information occurring within monthly group calls discussing implementation of an asthma SDM intervention. Previously published results showed that the patients from the practices that received the facilitator-led dissemination of the intervention had significantly higher perceptions of SDM occurring during asthma visits compared with patients from practices that received a traditional lunch-and-learn approach (75% vs 66%, p=0.001) 29 30. For this study, the research team examined dissemination of information between researchers including the practice facilitators (PFs), practice providers and clinical staff from each practice during the facilitator-led dissemination intervention.…”

Section: Introductionmentioning

confidence: 99%

What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

et al. 2020

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ObjectiveTo qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers.Setting10 primary care practices in North Carolina.ParticipantsProviders and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients.DesignThe research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge.ResultsAcross the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge.ConclusionThe research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science.Trial registration numberNCT02047929; Post-results

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“…While the aforementioned study explored patient perceptions of the lived asthma experience, there is minimal literature around HCPs’ insight into or expressions about what they perceive living with asthma is like for their patients. Rather, studies reporting HCP perspectives have focused on clinical areas such as asthma inhaler preference,23 24 medication adherence25 and interventions 26 27. As art allows creative expression of ideas and emotions that are not easily expressed in words, this would be a good medium for exploring both patient and HCP views.…”

Section: Introductionmentioning

confidence: 99%

‘It’s a powerful message’: a qualitative study of Australian healthcare professionals’ perceptions of asthma through the medium of drawings

2019

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ObjectivesThis study aimed to explore healthcare professionals’ (HCPs’) perspectives of asthma through their drawings, and their responses when viewing patients’ drawings of their experiences of asthma.DesignA qualitative exploratory study with a purposive, convenience sample of participants. Participants were asked to first express their perspectives of asthma in a drawing, which was followed by a review of drawings made by patients with asthma.SettingPrimary and tertiary HCPs from Sydney, Australia.ParticipantsTwenty-three HCPs from a range of health professions.ResultsThe HCPs illustrated their perspective of asthma through drawings which were largely biomedically framed, depicting physiological and clinical aspects of asthma. In contrast, their discussion around the patients’ drawings centred on the person more than the condition. The patients’ drawings triggered the HCPs to revisit their personal expectations of their patients’ illness experience; prompted differing degrees of acknowledgement and empathy regarding the patient experience; and encouraged clinical reflexivity.ConclusionsOur findings provide support for the educational application of patients’ drawings in bringing HCPs closer to the patient lived experience. The drawings fostered deeper insight into patient perspectives of asthma and stimulated critical reflection on current healthcare practices.

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Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices

Cited by 6 publications

References 47 publications

Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design

Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design

What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

‘It’s a powerful message’: a qualitative study of Australian healthcare professionals’ perceptions of asthma through the medium of drawings

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