Focusing the focus group: impact of the awareness of major factors contributing to non-adherence to acute paediatric asthma guidelines

Authors

  • Sanjit Kaur Bhogal MSc,

    1. PhD Candidate, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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  • David McGillivray MD,

    1. Associate Director in the Pediatric Emergency Department, and Associate Professor in Department of Pediatrics, Montréal Children's Hospital of the McGill University Hospital Centre, Montréal, Québec, Canada
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  • Jean Bourbeau MD MSc,

    1. Associate Professor, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada and Director, Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute of the McGill University Hospital Centre, Montréal, Québec, Canada
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  • Laurie H. Plotnick MD,

    1. Associate Director, Emergency Medicine, Montréal Children's Hospital of the McGill University Hospital Centre, Montréal, Québec, Canada and Assistant Professor, Department of Pediatrics, Montréal Children's Hospital of the McGill University Hospital Centre, Montréal, Québec, Canada
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  • Susan Joan Bartlett PhD,

    1. Associate Professor of Medicine, Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute of the McGill University Hospital Centre, Montréal, Québec, Canada
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  • Andrea Benedetti PhD,

    1. Assistant Professor, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada and Biostatistician for Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute of the McGill University Hospital Centre, Montréal, Québec, Canada
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  • Francine Monique Ducharme MD MSc

    Corresponding author
    1. Associate Director of Clinical Research, Research Centre, CHU Sainte-Justine, Professor, Department of Pediatrics, University of Montréal, Montréal, Québec, Canada and Associate Member, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada
      Francine M. Ducharme
      Associate Director of Clinical Research and Professor
      Department of Pediatrics
      CHU Sainte-Justine, 3175 Côte-Ste-Catherine
      Montreal QC H3T 1C5
      Canada
      E-mail: francine.m.ducharme@umontreal.ca
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  • This manuscript was presented in part at the American Thoracic Society Annual Meeting, May 19, 2008, Toronto, Ontario, Canada.

  • Conflict of interest: the authors report no conflict of interest. This manuscript is part of a PhD thesis by Sanjit K. Bhogal.

  • Authors' contributions: SKB (PhD candidate) conceived the study, and participated in its design and coordination, was involved with the analyses of barriers and interpretation of results, and drafted the manuscript. JB and FMD participated in the study design and coordination, interpretation of results, and supervised the writing of the manuscript. DM and LP participated in the study coordination, drafting of focus group questions, and were consulted in the analyses of barriers. SB and AB were involved with the interpretation of results, and review of the manuscript.

Francine M. Ducharme
Associate Director of Clinical Research and Professor
Department of Pediatrics
CHU Sainte-Justine, 3175 Côte-Ste-Catherine
Montreal QC H3T 1C5
Canada
E-mail: francine.m.ducharme@umontreal.ca

Abstract

Rationale  The administration of oral corticosteroids within the first hour in the emergency department is associated with reduced hospitalization rates in children with moderate and severe asthma, yet less than half of patients benefit from this recommendation. To ensure patients receive recommended treatment, a clear understanding of what is causing suboptimal care management is needed. The assessment of barriers and solutions to optimal care is often done without a thorough examination of the factors associated with non-adherence.

Objective  To evaluate whether knowledge of factors associated with delayed administration of systemic corticosteroids modifies the focus and prioritization of barriers and solutions identified by focus groups.

Methods  We conducted two parallel focus groups of emergency health care professionals – one group informed and the other non-informed of key factors. Both groups received a presentation on the acute asthma guidelines, the evidence supporting its recommendations, and current practice. In addition, the informed group was provided with the factors associated and not associated with delayed administration. The groups were given 20 minutes to discuss barriers and solutions, with 5 minutes each for voting for the main barriers and solutions. Group difference in the misdirection of discussion was measured as time spent discussing barriers that were shown not to be associated with systemic corticosteroids. Prioritization of barriers and solutions was based on group endorsement.

Results  The non-informed group spent more time discussing barriers not associated with delayed administration (15 vs. 2 minutes, P = 0.05). Although the non-informed group proposed more solutions, most were to overcome barriers not associated with delayed administration. Of the main barriers and solutions identified by each group, only one barrier and solution were similar between the two groups: emergency department overcrowding and administrating corticosteroids at triage.

Conclusion  The awareness of objective factors of non-adherence enabled a more directed discussion on relevant barriers and solutions, affecting prioritization of each. The administration of oral corticosteroids at triage appears to be the best solution to overcome delayed administration.

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