Les facilitateurs et les solutions à la pratique optimale des médecins dans le traitement de l’asthme

OBJECTIF : Déterminer les principales solutions qui facilitent la pratique optimale des médecins dans le traitement de l’asthme, incluant la prescription d’un médicament de contrôle à long terme et l’utilisation de plans d’action écrits. MÉTHODOLOGIE: Des entrevues individuelles semi-structurées ont été menées avec des médecins de différentes spécialités (médecins de famille, pédiatres, urgentologues, pneumologues et allergologues). Ces entrevues ont été transcrites puis analysées qualitativement de manière indépendante par deux chercheures qualifiées. RÉSULTATS : Quarante-deux médecins ont été interviewés. Un total de 867 facilitateurs et solutions ont été exprimés, répondant à trois de leurs besoins: (1) avoir du soutien dans la prestation de soins optimaux, (2) être habileté à aider et motiver les patients à suivre leurs recommandations et (3) avoir l’opportunité d’offrir des services efficients. À partir de ces données, une taxonomie de facilitateurs et de solutions comprenant dix catégories a également été développée. CONCLUSION : Les médecins ont proposé une multitude de facilitateurs et de solutions pour soutenir la pratique optimale. Ils varient essentiellement selon la spécialité et le comportement visé (prescription de médicaments de contrôle à long terme, utilisation de plans d’autogestion écrits et la gestion générale de l’asthme). Cela fait ressortir l’importance d’effectuer le choix des interventions en étroite collaboration avec les utilisateurs de connaissances afin d’obtenir des solutions qui soient perçues comme faisables et applicables, ayant ainsi potentiellement plus de chances de mener à un changement de pratique. La nouvelle taxonomie offre la possibilité d’utiliser un langage commun pour classifier les facilitateurs et les solutions.OBJECTIVE: To identify key solutions that facilitate physicians’ optimal practice in the treatment of asthma, including the prescription of long-term asthma controller medication and provision of written action plans. METHODOLOGY: Individual semi-structured interviews were conducted with physicians from different specialties (family physicians, pediatricians, emergency physicians, pulmonologists and allergists). Interviews were transcribed verbatim and analyzed independently, using qualitative method, by two trained researchers. RESULTS: Forty-two physicians were interviewed. A total of 867 facilitators and solutions were mentioned. They addressed three physicians’ needs: (1) support in delivering optimal care; (2) help to assist and motivate patients to follow medical recommendations; and (3) access to efficient services. From the data, the research team also developed a taxonomy of facilitators and solutions with ten categories. CONCLUSION: Physicians proposed multiple facilitators and solutions to support optimal practice. They varied across specialties and physician’s behaviour sought (prescription of long-term asthma controller, provision of written self-management plans, general asthma management). This highlights the importance of making the choice of interventions in collaboration with knowledge users to obtain solutions that are perceived as acceptable and effective, and who will potentially be more likely to lead to a practice change. The new taxonomy provides a common language for classifying facilitators and solutions

Initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID)

Individuals with an intellectual disability often require intensive services to promote their social participation to the fullest extent. As such, measuring satisfaction with these services appears essential to enhance the quality of life of individuals with an intellectual disability and to improve service delivery within agencies. Thus, the purpose of the study was to conduct an initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID), a 15-item questionnaire designed to assess service satisfaction. To examine the structure, reliability, and validity of the BASSPID, we interviewed 98 individuals with an intellectual disability and 23 parents. Overall, the BASSPID contained one scale, which had strong content and convergent validity as well as items easily understandable for individuals with an intellectual disability. Furthermore, the questionnaire had good internal consistency and adequate test-retest reliability. However, parents generally overestimated the perceived satisfaction of their child. The study suggests that the BASSPID may be useful to assess the satisfaction of individuals with an intellectual disability, but more research is needed to examine its potential impact on improving service quality

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians’ comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation

Facilitators and Solutions for Practicing Optimal Guided Asthma Self-Management: The Physician Perspective

OBJECTIVE: To identify key solutions that facilitate the prescription of long-term asthma controller and provision of written self-management plans by physicians