Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Eur Respir Rev. 2024 Nov 27;33(174). doi: 10.1183/16000617.0247-2023. Print 2024 Oct.
Asthma is one of the most common chronic respiratory diseases globally. Despite national and international asthma care guidelines, gaps persist in primary care. Knowledge translation (KT) electronic tools (eTools) exist aiming to address these gaps, but their impact on practice patterns and patient outcomes is variable. We aimed to conduct a nonsystematic review of the literature for key asthma care gaps and identify limitations and future directions of KT eTools optimised for use in electronic medical records (EMRs).
The database OVID Medline was searched (1999-2024) using keywords such as asthma, KT, primary healthcare and EMRs. Primary research articles, systematic reviews and published international/national guidelines were included. Findings were interpreted within the knowledge-to-action framework.
Key asthma care gaps in primary care include under-recognition of suboptimal control, underutilisation of pulmonary function tests, barriers to care delivery, provider attitudes/beliefs, limited access to asthma education and referral to asthma specialists. Various KT eTools have been validated, many with optimisation for use in EMRs. KT eTools within EMRs have been a recent focus, including asthma management systems, decision support algorithms, data standards initiatives and asthma case definition validation for EMRs.
The knowledge-to-action cycle is a valuable framework for developing and implementing novel KT tools. Future research should integrate end-users into the process of KT tool development to improve the perceived utility of these tools. Additionally, the priorities of primary care physicians should be considered in future KT tool research to improve end-user uptake and overall asthma management practices.
哮喘是全球最常见的慢性呼吸道疾病之一。尽管有国家和国际哮喘护理指南，但初级保健中仍存在差距。知识转化（KT）电子工具（eTools）旨在解决这些差距，但它们对实践模式和患者结果的影响是可变的。我们旨在对关键哮喘护理差距的文献进行非系统性综述，并确定经过优化可用于电子病历（EMR）的 KT eTools 的局限性和未来方向。
使用 OVID Medline 数据库（1999-2024 年）搜索关键词，如哮喘、KT、初级保健和 EMRs。纳入了原始研究文章、系统评价和已发表的国际/国家指南。研究结果在知识转化框架内进行了解释。
初级保健中关键的哮喘护理差距包括对控制不佳的识别不足、肺功能测试利用不足、护理提供障碍、提供者态度/信念、有限的哮喘教育和向哮喘专家转诊。已经验证了各种 KT eTools，其中许多已经针对 EMR 进行了优化。EMR 中的 KT eTools 是最近的重点，包括哮喘管理系统、决策支持算法、数据标准倡议和 EMR 中的哮喘病例定义验证。
知识转化周期是开发和实施新型 KT 工具的有价值框架。未来的研究应将最终用户纳入 KT 工具开发过程中，以提高这些工具的感知效用。此外，在未来的 KT 工具研究中应考虑初级保健医生的优先事项，以提高最终用户的采用率和整体哮喘管理实践。
