Sheikh Bahamdan Research Chair of Evidence-based Healthcare and Knowledge translation, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
BMC Health Serv Res. 2012 Jul 30;12:226. doi: 10.1186/1472-6963-12-226.
The prevalence of childhood bronchial asthma in Saudi Arabia has increased in less than a decade from 8% to 23%. Innovations in the management of asthma led to the development of evidence based clinical practice guidelines and protocols to improve the patients' outcomes. The objectives of this study are to examine the compliance of the healthcare providers in the Pediatrics Emergency Department, in King Khalid University Hospital, with the recommendations of the Pediatrics Asthma Management Protocol (PAMP), and to explore the reasons behind non-adherence.
This study is designed in 2 parts, a patients' chart review and a focus group interview. The medical records of all the children who presented to the Pediatric Emergency Department (PED) and were diagnosed as asthmatic, during the period from the 1st of January 2009 to the 31st of March 2009, were reviewed to investigate the compliance of healthcare providers (physicians and nurses) with 8 recommendations of the PAMP which are considered to be frequently encountered evidence-practice gaps, and these are 1) documentation of asthma severity grading by the treating physician and nurse 2) limiting the prescription of Ipratropium for children with severe asthma 3) administration of Salbutamol through an inhaler and a spacer 4) documentation of parental education 5) prescription of systemic corticosteroids to all cases of acute asthma 6) limiting chest x-ray requisition for children with suspected chest infection 7) management of all cases of asthma as outpatients, unless diagnosed as severe or life threatening asthma 8) limiting prescription of antibiotics to children with chest infection. The second part of this study is a focus group interview designed to elicit the reasons behind non-adherence to the recommendations detected by the chart review. Two separate focus group interviews were conducted for 10 physicians and 10 nurses. The focus group interviews were tape-recorded and transcribed verbatim. Theory-based content analysis was used to analyze interviews into themes and sub-themes.
A total of 657 charts were reviewed. The percentage of adherence by the healthcare providers to the 8 previously mentioned recommendations was established. There was non-adherence to the first 5 of the 8 aforementioned recommendations. Analysis of the focus group interview revealed 3 main themes as reasons behind non-compliance to the 5 recommendations mentioned above and those are 1) factors related to the organization, 2) factors related to the asthma management protocol 3) factors related to healthcare providers.
The organizational barriers and the lack of an implementation strategy for the protocol, in addition to the attitude and beliefs of the healthcare providers, are the main factors behind non-compliance to the PAMP recommendations.
在不到十年的时间里，沙特阿拉伯儿童支气管哮喘的患病率从 8%上升到 23%。哮喘管理方面的创新促成了基于证据的临床实践指南和方案的制定，以改善患者的治疗效果。本研究的目的是调查儿科急诊部医护人员对儿科哮喘管理方案（PAMP）建议的遵守情况，并探讨不遵守的原因。
本研究分为两部分，一部分是患者病历回顾，另一部分是焦点小组访谈。对 2009 年 1 月 1 日至 3 月 31 日期间在儿科急诊部就诊并被诊断为哮喘的所有儿童的病历进行了回顾性调查，以调查医护人员（医生和护士）对 PAMP 的 8 项建议的遵守情况，这些建议被认为是经常遇到的证据与实践之间的差距，包括：1）治疗医生和护士记录哮喘严重程度分级；2）限制对严重哮喘患儿使用异丙托溴铵；3）通过吸入器和储雾器给予沙丁胺醇；4）记录家长教育情况；5）所有急性哮喘患儿均使用全身皮质激素治疗；6）限制疑似胸部感染患儿的胸部 X 光检查；7）所有哮喘患儿均作为门诊患者管理，除非诊断为严重或危及生命的哮喘；8）限制胸部感染患儿使用抗生素。本研究的第二部分是焦点小组访谈，旨在了解病历回顾中发现的不遵守建议的原因。对 10 名医生和 10 名护士进行了两次单独的焦点小组访谈。对访谈进行了录音和逐字记录。采用基于理论的内容分析方法，将访谈内容分为主题和子主题。
共回顾了 657 份病历。确定了医护人员对上述 8 项建议的遵守程度。前 5 项建议未得到遵守。对焦点小组访谈的分析揭示了不遵守上述 5 项建议的 3 个主要原因，即 1）与组织相关的因素；2）与哮喘管理方案相关的因素；3）与医护人员相关的因素。
组织障碍和方案实施策略的缺乏，以及医护人员的态度和信念，是不遵守 PAMP 建议的主要原因。
