A multi-stakeholder perspective on asthma care in Canada: findings from a mixed methods needs assessment in the treatment and management of asthma in adults

Abstract

BackgroundAlthough several aspects of asthma care have been identified as being sub-optimal in Canada, such as patient education, practice guideline adoption, and access to care, there remains a need to determine the extent to which these gaps remain, so as to investigate their underlying causes, and potential solutions.MethodsAn ethics-approved mixed methods educational needs assessment was conducted in four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec), combining a qualitative phase (45-min semi-structured interviews with community-based healthcare providers and key stakeholders) and a quantitative phase (15-min survey, healthcare providers only).ResultsA total of 234 participants were included in the study, 44 in semi-structured interviews and 190 in the online survey. Five clinical areas were reported to be suboptimal by multiple categories of participants, and specific causes were identified for each. These areas included: Integration of guidelines into clinical practice, use of spirometry, individualisation of asthma devices to patient needs, emphasis on patient adherence and self-management, and clarity regarding roles and responsibilities of different members of the asthma healthcare team. Common causes for gaps in all these areas included suboptimal knowledge amongst healthcare providers, differing perceptions on the importance of certain interventions, and inadequate communication between healthcare providers.ConclusionsThis study provides a better understanding of the specific causes underlying common gaps and challenges in asthma care in Canada. This information can inform future continuing medical education, and help providers in community settings obtain access to adequate materials, resources, and training to support optimal care of adult patients with asthma.

A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis

“…, 21 , 22. , 24 , 26 , 31 Three studies were done in UK, 17 , 27 , 30 two studies in Canada, 25 , 28 one study in Indonesia, 19 one study in Denmark 23 and one study in USA. 29 …”

“…Studies mostly used semi-structured interviews as a method for data collection ( n = 11), 8 , 16 , 17. , 18 , 20 , 21 , 23 , 26 , 28 , 30 , 31 while five studies used focus group 19 , 24 , 25 , 27 , 29 and one study used both interviews and focus groups. 22 Only one study investigated healthcare professionals' perspectives through the medium of drawings.…”

“…30 , 31 Providing asthma care plans, documentation and monitoring peak flow were considered insignificant and difficult for many pharmacists. 28 , 29 , 31 However, pharmacists in one study believed that they could help in writing asthma care plans. 24 Most of the pharmacists expressed a positive attitude towards asthma guidelines, 17 , 24 but few pharmacists were aware of step-down guidance.…”

“…The reason for this according to pharmacists' views was related to patients' knowledge, patients' beliefs, culture, medication cost and lack of acceptance or confidence to provide this service by pharmacists. 8 , 20 , 23 , 29 Pharmacists reported young and busy adults were the most difficult patients to provide asthma care to, 28 and other evidence 29 reported men as the most uncooperative patients. As a result of perceived patient attitudes, pharmacists experienced fear, frustration, stress and worries about providing asthma services to patients.…”

“… -The process of data analysis was rigorous and the interpretation was evaluated by all authors. -Recruitment bias -Data coding was done by one researcher 8 28 Canada A multi-stakeholder perspective on asthma care in Canada: findings from a mixed method needs assessment in the treatment and management of asthma in adults. Community Pharmacy Semi-structured interview and online survey.…”