Facilitators and Barriers to the Implementation of the Primary Care Asthma Paediatric Pathway: A Qualitative Analysis
Bibliographic record
Abstract
Abstract ObjectiveThe Primary Care Asthma Paediatric Pathway (PCAPP) included an EMR embedded pathway that provided an evidence-based approach to paediatric asthma management. The aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the PCAPP in primary care.Methodsa randomized cluster-controlled design was implemented in 22 primary care practices in Alberta, Canada with half receiving the PCAPP intervention and the other half receiving usual care. Following the implementation of the complex intervention, a purposeful sample of intervention sites were selected to participate in qualitative focus groups to assess the barriers and facilitators to the implementation.ResultsOur qualitative findings are organized into three themes using the core constructs of the normalization process theory (NPT): (1) facilitators of implementation, (2) barriers to implementation, and (3) proposed mitigation strategies. Participants were positive about the pathway, and felt it served as a reminder of optimal paediatric guideline-based asthma management, a streamlined pathway multi-faceted approach to suggest evidence-based care, and an EMR-based targeted collection of tools and resources. Barriers included a generally low priority for the primary care teams, and, in accordance, clinicians suggested they had few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified clear mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a work-flow that incorporated the pathway.ConclusionOur study demonstrated the applicability of the NPT in the implementation of an evidence-based pathway for primary care. This study demonstrated it is important to ensure teams participate in enrolment (establishing buy-in), legitimization (ensuring teams see their role in the pathway) and activation (an ongoing plan for sustainability). Had these components of cognitive participation been addressed more carefully prior to implementation there may have been greater uptake, and ongoing use of the pathway. Trial Registration: This study was registered at clinicaltrials.gov on June 25, 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.007 | 0.005 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".