Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.
Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.
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DOI：
10.1093/intqhc/mzs043
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Nicoletti I
中科院分区：
文献类型：
--
作者：
Licskai C;Sands T;Ong M;Paolatto L;Nicoletti I
国际指南为哮喘护理建立了循证标准；然而，建议往往得不到落实，许多患者没有达到控制目标。区域试点数据表明，知识与实践之间存在差距。我们以加拿大卫生研究院知识翻译框架中描述的多步骤方法设计了卫生系统变革。知识转化发生在多个层面：患者、实践者和当地卫生系统。建立了区域行政基础设施和跨学科护理小组。可交付的关键项目是一项基于指南的跨学科哮喘管理计划。6个社区组织、33名初级保健医生和519名患者参加了会议。该计划的运营成本为每名患者290美元。在93%、95%、86%、100%、97%和87%的患者中实施了以指南为基础的6项护理要素，包括肺活量测量、哮喘控制治疗、书面自我管理行动计划和哮喘综合教育，包括吸入器技术、药物作用和环境控制策略。成人占66%，女性占61%，平均年龄35.7岁(SD=±24.2)岁。在基线时，42%的人在干预后有两个或两个以上的症状超过可接受的限度，而干预后的比例为17%(P<；0.001)；71%的人报告了基线时的紧急/紧急医疗就诊(2.94次/年)，45%的人(1.45%/年)(P<；0.001)；39%的人报告缺勤(5.0d/年)，19%的人(3.0d/年)(P<；0.001)。平均随访时间22(SD=±7)个月。知识转化框架可以指导多层次的组织变革，促进哮喘指南的实施，并在社区初级保健实践中改善健康结果。计划的费用与糖尿病计划的费用相似。计划节省的成本与成本之比为2.1：1
International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Regional pilot data demonstrated a knowledge-to-practice gap. We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months. A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1
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影响因子：
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作者：
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DOI：
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