Medicine, University of Alberta, Edmonton, Alberta, Canada
Pediatrics, University of Calgary, Calgary, Alberta, Canada.
BMJ Open. 2022 May 12;12(5):e058950. doi: 10.1136/bmjopen-2021-058950.
The aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the Primary Care Asthma Paediatric Pathway.
Qualitative semistructured focus groups following a randomised cluster-controlled design.
22 primary care practices in Alberta, Canada.
37 healthcare providers participated in four focus groups to discuss the barriers and facilitators of pathway implementation.
An electronic medical record (EMR) based paediatric asthma pathway, online learning modules, in-person training for allied health teams in asthma education, and a clinical dashboard for patient management.
Our qualitative findings are organised into three themes using the core constructs of the normalisation process theory: (1) Facilitators of implementation, (2) Barriers to implementation, and (3) Proposed mitigation strategies.
Participants were positive about the pathway, and felt it served as a reminder of paediatric guideline-based asthma management, and an EMR-based targeted collection of tools and resources. Barriers included a low priority of paediatric asthma due to few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a workflow that incorporated the pathway.
This study demonstrated the barriers and facilitators shaping the asthma pathway implementation. Our findings highlighted that if team support of (establishing buy-in), (ensuring teams see their role in the pathway) and (an ongoing plan for sustainability) there may have been greater uptake of the pathway.
This study was registered at clinicaltrials.gov on 25 June 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1.
本定性研究旨在采用基于理论的方法，了解影响初级保健儿童哮喘路径实施的促进因素和障碍因素。
采用随机群组对照设计的半结构式焦点小组。
加拿大艾伯塔省的 22 个初级保健诊所。
37 名医疗保健提供者参加了四个焦点小组，讨论了路径实施的障碍和促进因素。
基于电子病历（EMR）的儿科哮喘路径、在线学习模块、为哮喘教育领域的辅助医疗团队提供的现场培训以及用于患者管理的临床仪表板。
我们的定性发现使用正常化过程理论的核心结构组织为三个主题：（1）实施的促进因素，（2）实施的障碍，和（3）提出的缓解策略。
参与者对该路径持积极态度，并认为它起到了提醒儿科基于指南的哮喘管理的作用，并且是基于 EMR 的针对工具和资源的有针对性的收集。障碍包括由于实践中很少有哮喘儿童，因此对儿科哮喘的重视程度较低。该路径未集成到诊所流程中，也没有特定的流程来确保使用该路径。没有项目负责人的地点也更难以实施。尽管存在这些障碍，临床医生还是确定了提高采用率的缓解策略，包括在 EMR 中开发提醒系统，并创建一个纳入该路径的工作流程。
本研究证明了影响哮喘路径实施的障碍和促进因素。我们的研究结果强调，如果团队支持 （建立认可）、 （确保团队看到自己在路径中的角色）和 （可持续性的持续计划），可能会有更多的人采用该路径。
本研究于 2015 年 6 月 25 日在 clinicaltrials.gov 注册；注册号为：NCT02481037，https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1。
