To Teresa, McLimont Susan, Wang Chengning, Cicutto Lisa
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
BMC Health Serv Res. 2009 May 11;9:77. doi: 10.1186/1472-6963-9-77.
A comprehensive asthma care program (ACP) based on Canadian Asthma Consensus Guidelines was implemented in 8 primary care sites in Ontario, Canada. A survey was distributed to health care providers' (HCPs) to collect their opinions on the utilities of and barriers to the uptake of the ACP.
A 39-item self-administered survey was mailed to 184 HCPs and support staff involved in delivering the ACP at the end of implementation. The items were presented in mixed formats with most items requiring responses on a five-point Likert scale. Distributions of responses were analyzed and compared across types of HCPs and sites.
Of the 184 surveys distributed, 108 (59%) were returned, and of that, 83 were completed by HCPs who had clinical contact with the patients. Overall, 95% of the HCPs considered the ACP useful for improving asthma care management. Most HCPs favored using the asthma care map (72%), believed it decreased uncertainties and variations in patient management (91%), and considered it a convenient and reliable source of information (86%). The most commonly reported barrier was time required to complete the asthma care map. Over half of the HCPs reported challenges to using spirometry, while almost 40% identified barriers to using the asthma action plan.
Contrary to the notion that physicians believe that guidelines foster cookbook medicine, our study showed that HCPs believed that the ACP offered an effective and reliable approach for enhancing asthma care and management in primary care.
基于加拿大哮喘共识指南的综合哮喘护理项目(ACP)在加拿大安大略省的8个初级保健机构实施。向医疗保健提供者(HCPs)发放了一份调查问卷,以收集他们对ACP效用及采用障碍的看法。
在项目实施结束时,向参与提供ACP的184名HCPs和支持人员邮寄了一份39项的自填式调查问卷。问题以混合形式呈现,大多数问题要求在五点李克特量表上作答。分析并比较了不同类型HCPs和机构的回答分布情况。
在发放的184份调查问卷中,有108份(59%)被退回,其中83份由与患者有临床接触的HCPs完成。总体而言,95%的HCPs认为ACP有助于改善哮喘护理管理。大多数HCPs赞成使用哮喘护理地图(72%),认为它减少了患者管理中的不确定性和差异(91%),并认为它是一个方便可靠的信息来源(86%)。最常报告的障碍是完成哮喘护理地图所需的时间。超过一半的HCPs报告在使用肺活量测定法方面存在困难,而近40%的人指出在使用哮喘行动计划方面存在障碍。
与医生认为指南会催生照本宣科式医疗的观念相反,我们的研究表明,HCPs认为ACP为加强初级保健中的哮喘护理和管理提供了一种有效且可靠的方法。