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