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Adherence to guidelines for drug treatment of asthma in children: potential for improvement in Swedish primary care.

https://arctichealth.org/en/permalink/ahliterature122367
Source
Qual Prim Care. 2012;20(2):131-9
Publication Type
Article
Date
2012
Author
Maria Ingemansson
Björn Wettermark
Eva Wikström Jonsson
Maria Bredgard
Marina Jonsson
Gunilla Hedlin
Anna Kiessling
Author Affiliation
Paediatric Department, Astrid Lindgrens Hospital, Karolinska University Hospital, Sweden.
Source
Qual Prim Care. 2012;20(2):131-9
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Child
Child, Preschool
Female
Guideline Adherence
Humans
Infant
Male
Physician's Practice Patterns - statistics & numerical data
Primary Health Care
Quality of Health Care
Sweden
Abstract
Adherence to guidelines in general is poor. Because asthma is the most common chronic disease in Swedish children, identifying areas for improvement regarding drug treatment for asthma is crucial.
To explore the utilisation patterns of anti-asthmatic drugs in children with asthma in relation to evidence-based guidelines.
All children visiting 14 primary healthcare centres in Stockholm, Sweden, who had their first prescription of anti-asthmatic agents dispensed between July 2006 and June 2007 were followed over 24 consecutive months. The children (1033 in total) were divided in two age groups: 0-6 years and 7-16 years. The outcome measurements were: the characteristics of the physicians initiating drug treatment; the extent to which the children were initiated on the drugs recommended in the guidelines; and the amount and frequency of drugs dispensed over time and whether the dosage texts on the prescriptions contained adequate information.
In 54% of the older children and 35% of the younger children, only one prescription for anti-asthmatic drugs was dispensed during two years of follow-up following the first prescription. In school-aged children, 50% were initiated on inhaled short-acting bronchodilating beta2-agonists (SABA) in monotherapy. Among preschool children, 64% were initiated on SABA and inhaled corticosteroids in combination. In 41% of the prescriptions dispensed, the indication was stated and in 25% the mechanism of action was stated. Drug therapy was initiated by a general practitioner in 42% of the younger children and 72% of the older children.
There is a need for improvement in adherence to guidelines in important areas. Asthma, especially among children aged 7-16 years, is usually a chronic disease and should, in many cases, be treated with anti-asthmatics counteracting inflammation. However, this was not the case in our study. In addition, the dosage texts written by the physicians did not follow recommendations and may negatively influence patient safety.
PubMed ID
22824566 View in PubMed
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Practice guidelines in the context of primary care, learning and usability in the physicians' decision-making process--a qualitative study.

https://arctichealth.org/en/permalink/ahliterature261321
Source
BMC Fam Pract. 2014;15:141
Publication Type
Article
Date
2014
Author
Maria Ingemansson
Pia Bastholm-Rahmner
Anna Kiessling
Source
BMC Fam Pract. 2014;15:141
Date
2014
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Decision Making
Feedback
Female
Focus Groups
General practitioners
Guideline Adherence
Humans
Learning
Male
Physician's Practice Patterns
Practice Guidelines as Topic
Primary Health Care - methods
Qualitative Research
Sweden
Abstract
Decision-making is central for general practitioners (GP). Practice guidelines are important tools in this process but implementation of them in the complex context of primary care is a challenge. The purpose of this study was to explore how GPs approach, learn from and use practice guidelines in their day-to-day decision-making process in primary care.
A qualitative approach using focus-group interviews was chosen in order to provide in-depth information. The participants were 22 GPs with a median of seven years of experience in primary care, representing seven primary healthcare centres in Stockholm, Sweden in 2011. The interviews focused on how the GPs use guidelines in their decision-making, factors that influence their decision how to approach these guidelines, and how they could encourage the learning process in routine practice.Data were analysed by qualitative content analysis. Meaning units were condensed and grouped in categories. After interpreting the content in the categories, themes were created.
Three themes were conceptualized. The first theme emphasized to use guidelines by interactive contextualized dialogues. The categories underpinning this theme: 1. Feedback by peer-learning 2. Feedback by collaboration, mutual learning, and equality between specialties, identified important ways to achieve this learning dialogue. Confidence was central in the second theme, learning that establishes confidence to provide high quality care. Three aspects of confidence were identified in the categories of this theme: 1. Confidence by confirmation, 2. Confidence by reliability and 3. Confidence by evaluation of own results. In the third theme, learning by use of relevant evidence in the decision-making process, we identified two categories: 1. Design and lay-out visualizing the evidence 2. Accessibility adapted to the clinical decision-making process as prerequisites for using the practice guidelines.
Decision-making in primary care is a dual process that involves use of intuitive and analytic thinking in a balanced way in order to provide high quality care. Key aspects of effective learning in this clinical decision-making process were: contextualized dialogue, which was based on the GPs' own experiences, feedback on own results and easy access to short guidelines perceived as trustworthy.
Notes
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PubMed ID
25143046 View in PubMed
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