title: Focusing the focus group: impact of the awareness of major factors contributing to non-adherence to acute paediatric asthma guidelines.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
authors.forename: Sanjit Kaur
authors.initials: SK
authors.lastname: Bhogal
authors.forename: David
authors.initials: D
authors.lastname: McGillivray
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Plotnick
authors.forename: Susan Joan
authors.initials: SJ
authors.lastname: Bartlett
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.forename: Francine Monique
authors.initials: FM
authors.lastname: Ducharme
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001364:Awareness; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010372:Pediatrics; D011792:Quebec
chemical_list: D000305:Adrenal Cortex Hormones