Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

Abstract

BackgroundAsthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care.MethodsWe designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention.ResultsSeven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/− 3.1 pre- to 27.3 +/− 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively.ConclusionsA mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0220-6) contains supplementary material, which is available to authorized users.

Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review

“…Of the 17 studies included in this systematic review: six investigated patient health outcomes of 1746 patients [ 22 – 27 ]; 14 investigated process of care measures for 38,483 episodes of patient care [ 24 – 37 ]; and three studies investigated the health care experience of 1856 patients [ 25 , 35 , 38 ]. Five studies investigated direct supervision [ 25 , 31 , 33 – 35 ], six studies investigated debriefing/reflective practice [ 22 – 24 , 26 – 28 , 38 ] and five studies investigated a combination of direct supervision and debriefing/reflective practice [ 29 , 30 , 32 , 36 , 37 ]. Four studies investigated clinical supervision of medical professionals [ 25 , 28 , 34 , 35 ], seven studies investigated clinical supervision of nursing professionals [ 23 , 29 – 32 , 37 , 38 ], two studies investigated clinical supervision of allied health professionals [ 22 , 24 ] and three studies investigated supervision of a combination of health professions [ 26 , 27 , 33 , 36 ].…”

“…Five studies investigated direct supervision [ 25 , 31 , 33 – 35 ], six studies investigated debriefing/reflective practice [ 22 – 24 , 26 – 28 , 38 ] and five studies investigated a combination of direct supervision and debriefing/reflective practice [ 29 , 30 , 32 , 36 , 37 ]. Four studies investigated clinical supervision of medical professionals [ 25 , 28 , 34 , 35 ], seven studies investigated clinical supervision of nursing professionals [ 23 , 29 – 32 , 37 , 38 ], two studies investigated clinical supervision of allied health professionals [ 22 , 24 ] and three studies investigated supervision of a combination of health professions [ 26 , 27 , 33 , 36 ]. Clinical supervision was conducted weekly in three studies [ 25 , 26 , 28 ], fortnightly in two studies [ 23 , 30 ] and monthly in four studies [ 29 , 32 , 33 , 37 ].…”

“…Clinical supervision was conducted weekly in three studies [ 25 , 26 , 28 ], fortnightly in two studies [ 23 , 30 ] and monthly in four studies [ 29 , 32 , 33 , 37 ]. Four studies did not report frequency of supervision sessions [ 34 – 36 , 38 ] and two studies reported supervision sessions occurring following a clinical event/consultation [ 24 , 27 ]. The quantity of supervision sessions was reported in two studies with participants receiving 40 h of supervision in one study [ 31 ] and 8 sessions in another [ 22 ].…”

Choosing wisely: The Canadian Thoracic Society's list of six things that physicians and patients should question

“…In fact, it may be feasible to design a single spirometry implementation strategy to address both recommendations. However, we note that spirometry underuse is a gap that has been described in primary care 40 and is less likely to be a major gap in specialty respiratory care (given that access to testing is not a barrier). Accordingly, these recommendations do not align with the selection and prioritization criterion that specified that recommendations should pertain to practices performed by respirologists.…”

Topical Issues of Clinical Application of Spirometry

“…Несмотря новую классификацию степени тяжести ХОБЛ [17], не теряет своей актуальности существовавшая ранее, основанная на величине постбронходилатационного ОФВ 1 при отношении ОФВ 1 /ФЖЕЛ<0,7 [18] (табл. 2).…”