Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Abstract

Quality problemInternational guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets.Initial assessmentRegional pilot data demonstrated a knowledge-to-practice gap.Choice of solutionsWe engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework.ImplementationKnowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient.EvaluationSix guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months.Lessons learnedA knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

“…The literature also reports 70,71 on the small number of studies applying a theoretical background and encourages its use tailored to the setting and to the aim of intervention. 70 Economic evaluation of guideline implementation interventions is rarely reported, 12,13 our hits demonstrating no exception: three studies 31,35,41 presented cost-benefit or cost-effectiveness information. This indicates that research should focus on adding this essential aspect in favour of comprehensive comparability.…”

“…34,40,44,47,54,57,58 (3) Seven studies used diverse single approaches including audit, 25,31,43 motivational interview, 53 reminder 26,32 and patient-mediated intervention. 41 Multifaceted interventions mainly applied a combination of two methods, one of them a kind of training approach, extended by a second methodologically different method. From these, (4) the combination of educational meeting and audit/feedback was the most frequent with four studies.…”

Child Neurology Practice Guidelines: Past, Present, and Future

“…65 Reduction in urgent care and emergency room visits for children with asthma has been seen from asthma care guideline use. 66 Protocol adherence for seizure management in the emergency department and pediatric intensive care unit also has been shown to be beneficial for patients. 67,68 Practice guidelines need to be reviewed and updated.…”

Development and pilot testing of a mobile health solution for asthma self‐management: Asthma action plan smartphone application pilot study

“…A convenience sample of subjects recruited from the Primary Care Asthma Program in Windsor, Ontario, was used. This population has been described previously (8). Adults (>18 years of age) with a physician diagnosis of asthma who reported symptom worsening with exposure to air pollution were enrolled.…”

“…It is a communication tool that supports patients in the assessment of asthma control and directs management decisions that occur between regular clinic visits. In the context of regular clinical review, the written asthma action plan has been demonstrated to be efficacious in multiple randomized controlled trials and demonstrated to be effective as a component of care in community asthma programs (7)(8)(9).…”