Villa-Roel Cristina, Ospina Maria, Majumdar Sumit R, Couperthwaite Stephanie, Rawe Erin, Nikel Taylor, Rowe Brian H
Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.
Department of Obstetrics & Gynecology, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.
BMC Health Serv Res. 2018 Oct 19;18(1):789. doi: 10.1186/s12913-018-3587-7.
Multifaceted interventions driven by the needs of patients and providers can help move evidence into practice more rapidly. This study engaged both patients and primary care providers (PCPs) to help design novel opinion leader (OL)-based interventions for patients with acute asthma seen in emergency departments (EDs).
A mixed methods design was employed. In phase I, we invited convenience samples of patients with asthma presenting to the ED and PCPs to participate in a survey. Perceptions with respect to: a) an ideal OL-profile for asthma guidance; and b) content, style and delivery methods of OL-based interventions in acute asthma directed from the ED were collected. In phase II, we conducted focus groups to further explore preferences and expectations for such interventions with attention to barriers and facilitators for implementation.
Overall, 54 patients completed the survey; 39% preferred receiving guidance from a respirologist, 44% during their ED visit and 56% through individual discussions. In addition, 55% expressed interest in having PCP follow-up within a week of ED discharge. A respirologist was identified as the ideal OL-profile by 59% of the 39 responding PCPs. All expressed interest in receiving notification of their patients' ED presentation, most within a week and including diagnosis and ED/post ED-treatment. Personalized, guideline-based, recommendations were considered to be the ideal content by the majority; 39% requested this guidance through a pamphlet faxed to their offices. In the focus groups, patients and PCPs recognized the importance of health professional liaisons in transitions in care; patient anxiety and PCP time constraints were identified as potential barriers for ED-educational information uptake and proper post-ED follow-up, respectively.
Engaging patients and PCPs yielded actionable information to tailor OL-based multifaceted interventions for acute asthma in the ED. We identified potential facilitators for the implementation of such interventions (e.g., patient interaction with alternative health care professionals who could facilitate transitions in asthma care between the ED and the primary care setting), and for the provision of post discharge self-management education (e.g., consideration of the first week of ED discharge as a practical time frame for this intervention). Prioritization of identified barriers (e.g., lack of PCP involvement) could be addressed by the identification of potential early adopters in practice environments (e.g., clinicians with special interest in asthma).
由患者和医疗服务提供者的需求驱动的多方面干预措施有助于更迅速地将证据应用于实践。本研究让患者和初级保健提供者（PCP）共同参与，以帮助设计针对在急诊科（ED）就诊的急性哮喘患者的新型基于意见领袖（OL）的干预措施。
采用混合方法设计。在第一阶段，我们邀请了到急诊科就诊的哮喘患者和初级保健提供者的便利样本参与一项调查。收集了关于以下方面的看法：a）哮喘指导的理想意见领袖形象；b）急诊科针对急性哮喘的基于意见领袖的干预措施的内容、风格和交付方式。在第二阶段，我们进行了焦点小组讨论，以进一步探讨对此类干预措施的偏好和期望，并关注实施的障碍和促进因素。
总体而言，54名患者完成了调查；39%的患者倾向于接受呼吸科医生的指导，44%的患者希望在急诊科就诊期间获得指导，56%的患者希望通过个人讨论获得指导。此外，55%的患者表示有兴趣在急诊科出院后一周内接受初级保健提供者的随访。在39名回复的初级保健提供者中，59%认为呼吸科医生是理想的意见领袖形象。所有人都表示有兴趣收到其患者急诊科就诊情况的通知，大多数希望在一周内收到，包括诊断和急诊科/急诊科后治疗情况。大多数人认为基于指南的个性化建议是理想的内容；39%的人要求通过传真到其办公室的宣传册获得此指导。在焦点小组中，患者和初级保健提供者认识到医疗专业人员联络在护理过渡中的重要性；患者焦虑和初级保健提供者的时间限制分别被确定为急诊科教育信息获取和急诊科后适当随访的潜在障碍。
让患者和初级保健提供者参与产生了可操作的信息，以定制针对急诊科急性哮喘的基于意见领袖的多方面干预措施。我们确定了实施此类干预措施的潜在促进因素（例如，患者与替代医疗保健专业人员的互动，这可以促进急诊科和初级保健环境之间哮喘护理的过渡），以及提供出院后自我管理教育的促进因素（例如，将急诊科出院后的第一周视为该干预措施的实际时间框架）。通过在实践环境中确定潜在的早期采用者（例如，对哮喘有特别兴趣的临床医生），可以解决已确定障碍的优先级问题（例如，缺乏初级保健提供者的参与）。
