IN AN EMERGENCY ROOM IN SAUDI ARABIA, THE REASONS UNDERLYING THE NON-ADHERENCE OF HEALTHCARE PRACTITIONERS TO GUIDELINES FOR ASTHMA IN CHILDREN
Main Article Content
Keywords
#
Abstract
Brief history In Saudi Arabia, the prevalence of bronchial asthma in children has climbed from 8% to 23% in a span of less than a decade. The establishment of evidence-based clinical practice standards and protocols for the management of asthma was a direct result of innovations in asthma management, which led to improvements in the outcomes for patients. The purpose of this research is to investigate the causes underlying non-adherence to the recommendations of the Paediatrics Asthma Management Protocol (PAMP) and to investigate the degree to which healthcare personnel in the Paediatrics Emergency Department at King Khalid University Hospital comply with those guidelines. Techniques Two components make up this research project: a review of the patients' medical records and an interview with a focus group. The medical records of all the children who presented to the Paediatric Emergency Department (PED) and were diagnosed with asthma during the period beginning on the first of January 2009 and ending on the 31st of March 2009 were reviewed in order to investigate the compliance of healthcare providers (physicians and nurses) with eight recommendations of the PAMP. These recommendations are considered to be frequently encountered evidence-practice gaps, and they are as follows: 1) documentation of the nursing staff and the treating physician's assessment of the severity of the asthma 2) restricting the quantities of ipratropium that can be prescribed to children who have severe asthma The third method involves the use of an inhaler and a spacer to administer salbutamol. 4) The submission of paperwork about the education of the parents 5) The prescription of systemic corticosteroids for all cases of acute asthma 6) restricting the number of chest x-rays that can be requested for children who have a suspected chest infection 7) The administration of all instances of asthma as outpatients, unless the asthma is so severe or life-threatening that it requires hospitalisation 8). restricting the amount of antibiotics that can be prescribed to children who have a chest infection. A focus group interview is the second component of this research project. The purpose of this interview is to elicit the reasons behind the non-adherence to the suggestions that were discovered through the chart review. Two distinct interviews with focus groups were carried out with a total of ten nurses and ten practicing physicians. All of the interviews with the focus group were recorded on tape and then transcribed word for word. For the purpose of identifying themes and sub-themes, theory-based content analysis was utilised to analyse the interviews. The findings and the subsequent discussion There were a total of 657 charts that were examined. A determination was made regarding the percentage of healthcare providers that adhered to the eight recommendations that were presented before. It was found that the first five of the eight recommendations that were presented before were not followed. The analysis of the interview with the focus group revealed three key themes as causes for non-compliance with the five suggestions mentioned above. These themes are as follows: 1) factors linked to the organisation, 2) factors related to the asthma management protocol, and 3) issues related to healthcare professionals. Final Thoughts The primary reasons for non-compliance with the PAMP recommendations are the organisational hurdles and the absence of an implementation strategy for the protocol. Additionally, the attitude and beliefs of the healthcare providers are also a contributing factor.
Downloads
References
1. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S: Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009, 64: 476-483. 10.1136/thx.2008.106609. Article CAS PubMed Google Scholar 2. Cardarelli WJ: Asthma: are we monitoring the correct measures?. Popul Health Manag. 2009, 12: 87-94. 10.1089/pop.2008.0021. Article PubMed Google Scholar 3. Al-Moamary MS, Al-Hajjaj MS, Idrees MM, Zeitouni MO, Alanezi MO, Al-Jahdal HH, et al: The Saudi Initiative for asthma. Ann Thorac Med. 2009, 4: 216-233. 10.4103/1817-1737.56001. Article PubMed PubMed Central Google Scholar 4. Al Frayh AR: Asthma patterns in Saudi Arabian children. J R Soc Health. 1990, 110: 98-100. 10.1177/146642409011000309. Article CAS PubMed Google Scholar 5. Hijazi N, Abalkhail B, Seaton A: Asthma and respiratory symptoms in urban and rural Saudi Arabia. Eur Respir J. 1998, 12: 41-44. 10.1183/09031936.98.12010041. Article CAS PubMed Google Scholar 6. Self TH, Usery JB, Howard-Thompson AM, Sands C: Asthma treatment protocols in the emergency department: are they effective?. J Asthma. 2007, 44: 243-248. 10.1080/02770900701246691. Article PubMed Google Scholar 7. Gustafsson PM, Watson L, Davis KJ, Rabe KF: Poor asthma control in children: evidence from epidemiological surveys and implications for clinical practice. Int J Clin Pract. 2006, 60: 321-334. 10.1111/j.1368-5031.2006.00798.x. Article CAS PubMed Google Scholar 8. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, et al: Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004, 114: 40-47. 10.1016/j.jaci.2004.04.042. Article PubMed Google Scholar 9. Field MJ, Lohr KN: Guidelines for clinical practice: from development to use. Institute of Medicine. 1992, National Academy Press, Washington, D.C Google Scholar 10. Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001, 39: II46-II54. Article CAS PubMed Google Scholar 11. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8: 72. Article Google Scholar 12. Rogers EM: Diffusion of innovations, 5th ed edn. 2003, Free Press, New York Google Scholar 13. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x. Article PubMed PubMed Central Google Scholar 14. Gildenhuys J, Lee M, Isbister GK: Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?. Int J Emerg Med. 2009, 2: 33-39. 10.1007/s12245-008-0063-x. Article PubMed Google Scholar 15. Bousquet J, Clark TJ, Hurd S, Khaltaev N, Lenfant C, O'byrne P, et al: GINA guidelines on asthma and beyond. Allergy. 2007, 62: 102-112. CAS PubMed Google Scholar 16. Kitzinger J: Qualitative research:introducing focus groups. Br Med J. 1995, 311: 299-302. 10.1136/bmj.311.7000.299. Article CAS Google Scholar 17. Freeman T: 'Best practice' in focus group research: making sense of different views. J Adv Nurs. 2006, 56: 491-497. 10.1111/j.1365-2648.2006.04043.x. Article PubMed Google Scholar 18. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res. 2005, 15: 1277-1288. 10.1177/1049732305276687. Article PubMed Google Scholar 19. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008, 3: 1-10.1186/1748-5908-3-1. Article PubMed PubMed Central Google Scholar 20. Logan J, Graham ID: Toward a comprehensive interdisciplinary model of health care research use. Science communication. 1998, 20: 227-246. 10.1177/1075547098020002004. Article Google Scholar 21. Kontos PC, Poland BD: Mapping new theoretical and methodological terrain for knowledge translation: contributions from critical realism and the arts. Implement Sci. 2009, 4: 1-10.1186/1748-5908-4-1. Article PubMed PubMed Central Google Scholar 22. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al: Lost in knowledge translation: time for a map?. J Contin Educ Health Prof. 2006, 26: 13-24. 10.1002/chp.47. Article PubMed Google Scholar 23. Francke AL, Smit MC, de Veer AJ, Mistiaen P: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008, 8: 38-10.1186/1472-6947-8-38. Article PubMed PubMed Central Google Scholar 24. Tooher R, Middleton P, Babidge W: Implementation of pressure ulcer guidelines: what constitutes a successful strategy?. J Wound Care. 2003, 12: 373-2. Article CAS PubMed Google Scholar 25. Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al: Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol. 2006, 108: 1234-1245. 10.1097/01.AOG.0000236434.74160.8b. Article PubMed Google Scholar 26. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282: 1458-1465. 10.1001/jama.282.15.1458. Article CAS PubMed Google Scholar 27. Tinetti ME, Bogardus ST, Agostini JV: Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004, 351: 2870-2874. 10.1056/NEJMsb042458. Article CAS PubMed Google Scholar 28. Levy ML, Thomas M, Small I, Pearce L, Pinnock H, Stephenson P: Summary of the 2008 BTS/SIGN British Guideline on the management of asthma. Prim Care Respir J. 2009, 18 (Suppl 1): S1-16. Article PubMed Google Scholar 29. Cabana MD, Ebel BE, Cooper-Patrick L, Powe NR, Rubin HR, Rand CS: Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med. 2000, 154: 685-693. Article CAS PubMed Google Scholar 30. Davis DA, Taylor-Vaisey A: Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997, 157: 408-416. CAS PubMed PubMed Central Google Scholar Pre-publication history • The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/226/prepub
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.