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首页> 外文期刊>BMC Health Services Research >Engaging patients and primary care providers in the design of novel opinion leader based interventions for acute asthma in the emergency department: a mixed methods study
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Engaging patients and primary care providers in the design of novel opinion leader based interventions for acute asthma in the emergency department: a mixed methods study

机译：让患者和初级保健提供者参与急诊科基于新颖意见领袖的急性哮喘干预措施的设计：混合方法研究

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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).
机译：由患者和提供者的需求驱动的多方面干预可以帮助将证据更快地付诸实践。这项研究让患者和初级保健提供者（PCP）参与进来，以帮助设计基于新意见领袖（OL）的急诊科（ED）所见急性哮喘患者的干预措施。采用了混合方法设计。在第一阶段，我们邀请了急诊科和急诊科的哮喘患者样本参加调查。关于以下方面的看法：a）理想的OL指导哮喘指南; b）收集了由ED指导的基于OL的急性哮喘干预的内容，方式和提供方法。在第二阶段，我们进行了焦点小组讨论，进一步探讨了对此类干预措施的偏好和期望，并关注实施的障碍和促进者。总体上，有54位患者完成了调查。 39％的人倾向于接受呼吸科医师的指导，44％的人在急诊室就诊，56％的人通过个人讨论。此外，有55％的人表示有兴趣在ED出院后一周进行PCP随访。在39个有反应的PCP中，有59％将呼吸科医师确定为理想的OL模式。所有人都表示有兴趣在大多数一周内收到患者有关ED表现的通知，包括诊断和ED / ED治疗后。多数人认为基于指南的个性化建议是理想的内容; 39％的人通过传真到其办公室的小册子要求提供此指南。在焦点小组中，患者和初级保健医生认识到卫生专业联络员在护理过渡中的重要性。病人焦虑和PCP时间限制分别被确定为ED教育信息吸收和适当的ED后随访的潜在障碍。与患者和PCP交往产生了可操作的信息，以针对急诊科急诊哮喘制定基于OL的多方面干预措施。我们确定了实施此类干预措施的潜在推动者（例如，患者与替代性医疗保健专业人员的互动，这些人员可以促进急诊室和初级保健机构之间的哮喘护理过渡），并提供出院后自我管理教育（例如，将ED出院的第一周作为该干预措施的实际时间表。可以通过在实践环境中识别潜在的早期采用者（例如，对哮喘特别感兴趣的临床医生）来解决已确定的障碍的优先级（例如，缺乏PCP参与）。

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