translation Archives - World Asthma Foundation

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

Int J Qual Health Care. 2012 Aug 14;

Authors: Licskai C, Sands T, Ong M, Paolatto L, Nicoletti I

Abstract
Quality problemInternational guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets.Initial assessmentRegional pilot data demonstrated a knowledge-to-practice gap.Choice of solutionsWe engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework.ImplementationKnowledge 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.EvaluationSix 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.Lessons learnedA 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.

PMID: 22893665 [PubMed – as supplied by publisher]

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Asthma guidelines implementation: a guide to the translation of GINA guidelines into improved care.

Eur Respir J. 2012 Jan 26;

Authors: Boulet LP, Fitzgerald JM, Levy ML, Cruz AA, Pedersen S, Haahtela T, Bateman ED

Abstract
In 1995 the Global Initiative on Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and country initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socio-economic settings.

PMID: 22282546 [PubMed – as supplied by publisher]

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