Sharpe H, Claveria-Gonzalez FC, Davidson W, Befus AD, Leung JP, Young E, Walker B. Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices.
SAGE Open Nurs 2020;
6:2377960820925984. [PMID:
33415281 PMCID:
PMC7774341 DOI:
10.1177/2377960820925984]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/18/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction
An estimated 8.1% of Canadians adults have asthma. While there are challenges
associated with the use of objective measurement of lung function in the
diagnosis of asthma, we are uncertain of the barriers that impact the use of
objective measures, and have limited understanding of the challenges
experienced by primary care providers in diagnosis of asthma. The objectives
of this quality improvement initiative were to identify primary care
providers’ methods of diagnosing asthma and to identify challenges with
diagnosis.
Methods
An online survey was disseminated using a snowball methodology.
Setting
Primary care practices in Alberta, Canada.
Participants
A total of 84 primary care providers completed the survey.
Main Outcome Measures
Participants were asked their ideal and
sufficient methods for diagnosing asthma and to
identify challenges in their practice related to asthma diagnosis.
Results
They identified full pulmonary function testing (54%), pre- and
postbronchodilator spirometry (54%), complete history and physical (42%),
peak flow measurement overtime (26%), pulmonary consult (26%), and trial of
asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most
significant barriers to diagnosis included episodic care–care provided
typically during times of worsening symptoms without ongoing
preventative/maintenance care (55%), patient follow-up (44%), conflict
between clinical impression and pulmonary function results (43%), patient
already on asthma medications (43%), and interpreting spirometry/pulmonary
function results (39%).
Conclusion
The results of this survey indicate that the majority of primary care
providers would choose full pulmonary function testing or pre- and
postbronchodilator spirometry as the ideal methods of diagnosing asthma.
However, barriers related to the nature of asthma care, patient factors, and
challenges with diagnostic testing create challenges. This study also
highlights that primary care providers have adapted to challenges in
leveraging objective measurement and may rely upon other methods for
diagnosis such as trials of medications.
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