Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care

Yamada, Janet; Cheung, Jeffrey Lam Shin; Gagné, Myriam; Spiegel-Feld, Carolyn; Aaron, Shawn D.; FitzGerald, J. Mark; Gershon, Andrea S.; Gupta, Samir

doi:10.1016/j.chest.2021.10.030

Cited by 19 publications

(17 citation statements)

References 55 publications

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“…In order to consider the specific limitations of KT eTools in the diagnosis and surveillance of asthma, we need to understand the broader system factors that lead to suboptimal diagnosis of asthma in primary care. Previous publications, including a recent publication by Yamada et al have identified several such barriers that can be categorized in the following themes: knowledge, skills, social/professional role and identity, beliefs about capabilities, reinforcement, intentions, goals, memory and decision processes, environmental context and resources, social influences, emotions, and behavioural regulation [ 61 ]. Figure 1 provides a root cause analysis for suboptimal asthma diagnosis in primary care, outlining several of these key factors.…”

Section: Discussionmentioning

confidence: 99%

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Moloney

Digby

MacKinnon

et al. 2023

Allergy Asthma Clin Immunol

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Background Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. Methods Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. Results Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. Conclusion Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.

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Section: Discussionmentioning

confidence: 99%

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Moloney

Digby

MacKinnon

et al. 2023

Allergy Asthma Clin Immunol

Self Cite

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“…In our study, rather than these views relating to decreased value placed on preventative care, the impact of ‘environmental context and resources’ was commonly mentioned. Like other studies, time constraints, staffing challenges and reduced resources were cited as barriers to preventative discussions where COPD was often contextualised within a larger picture 21,24,26 . COPD was viewed as only one condition amongst many others requiring GP attention during short consults, whereas other symptoms the patient may complain of would be viewed as more pressing to address.…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative research that explores the acceptability, challenges and facilitators to implementation of interventions is essential for evaluating the effectiveness of new models of care 20 and can inform ways in which interventions and service delivery models could be best integrated into clinical practice. 20 While there are some studies examining the acceptability of case-finding for COPD, [21][22][23][24][25][26][27] there is a paucity of literature looking at the acceptability of multidisciplinary models of care in the management of COPD once the diagnosis has been made. 16 This study is important, as there is currently no published literature on the acceptability of a GP-physiotherapist partnership as well as the acceptability of this model in an Australian primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

Pagano,

McKeough,

Wootton

et al. 2023

Health Expectations

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IntroductionChronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)–physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model.MethodsSemi‐structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp‐physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews.ResultsAll clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence‐based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self‐management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers.ConclusionsAn experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation.Patient or Public ContributionPatient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients. Trial Registration: ACTRN12619001127190

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“…Some environmental factors can trigger or stimulate asthma, such as pollen, excessively cold climate, strenuous exercise or pets ( Sonney et al, 2022 ). Asthma can cause recurrent episodes of wheezing, shortness of breath, chest tightness, and/or coughing ( Yamada et al, 2022 ). In addition, these emergencies often occur at night/morning.…”

Section: Introductionmentioning

confidence: 99%

N⁶-methyladenosine reader YTHDF1 regulates the proliferation and migration of airway smooth muscle cells through m⁶A/cyclin D1 in asthma

Wang

Tian

et al. 2023

PeerJ

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Asthma is a chronic inflammatory respiratory disease, which is involved in multiple pathologic molecular mechanisms and presents a huge challenge to clinic nursing. Emerging evidence suggests that N6-methyladenosine (m6A) plays critical roles in respiratory system disease. Thus, present work tried to investigate the functions of m6A reader YTHDF 1 in asthma. The results indicated that YTHDF1 significantly upregulated in platelet-derived growth factor (PDGF) induced airway smooth muscle cells (ASMCs). Functionally, overexpression of YTHDF1 promoted the proliferation and migration of ASMCs, while YTHDF1 knockdown repressed the proliferation and migration. Mechanistically, there was a m6A modification site on cyclin D1 RNA (CCND1 genome) and YTHDF1 combined with cyclin D1 mRNA, thereby enhancing its mRNA stability via m6A-dependent manner. Collectively, these findings reveal a novel axis of YTHDF1/m6A/cyclin D1 in asthma’s airway remodeling, which may provide novel therapeutic strategy for asthma.

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Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care

Cited by 19 publications

References 55 publications

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

N⁶-methyladenosine reader YTHDF1 regulates the proliferation and migration of airway smooth muscle cells through m⁶A/cyclin D1 in asthma

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Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care

Cited by 19 publications

References 55 publications

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

N6-methyladenosine reader YTHDF1 regulates the proliferation and migration of airway smooth muscle cells through m6A/cyclin D1 in asthma

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N⁶-methyladenosine reader YTHDF1 regulates the proliferation and migration of airway smooth muscle cells through m⁶A/cyclin D1 in asthma