Facilitators and solutions for practicing optimal guided asthma self-management: the physician perspective.
OBJECTIVE
To identify key solutions that facilitate the prescription of long-term asthma controller and provision of written self-management plans by physicians.


METHODS
One hour individualized semistructured interviews were conducted with physicians. Interviews were transcribed verbatim and analyzed independently by two trained qualitative researchers. A taxonomy of facilitators (contemplated solutions) and experienced solutions was achieved by consensus within the research team.


RESULTS
Forty-two physicians (family physicians, pediatricians, emergency physicians, pulmonologists and allergists) were interviewed. The 867 facilitators and solutions, grouped in 10 categories, addressed three physician needs: support physicians in delivering optimal care (guideline dissemination, workplace culture, physician training and experience, physician attitudes toward optimal practice, tools and resources supporting physicians' decision making); assist patients with following recommendations (patient characteristics, experiences and attitudes; physician behaviour; and tools and resources supporting patient self-management); and offer efficient services (reorganization of care; interprofessional patient management). Suggestions pertaining to the latter two categories were most frequently cited to optimize asthma management and use of self-management plans (e.g., access to self-management plans; education by allied health care professionals). The most cited suggestions to support prescribing long-term controller pertained to physician behaviour (e.g., involvement in patient education, personalization of prescriptions, feedback to patients of the benefits of long-term controller). The distribution of facilitators and solutions varied across specialties.


CONCLUSIONS
Physicians proposed multiple facilitators and solutions to support optimal practice, leading to the development of a novel taxonomy. Key suggestions varied across physician specialties and behaviours sought, emphasizing the need to carefully select the most promising knowledge translation interventions.
Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec.
Alexandrine J
AJ
Lamontagne
Sandra
S
Pelàez
Roland
R
Grad
Lucie
L
Blais
Kim L
KL
Lavoie
Simon L
SL
Bacon
Hélène
H
Guay
Annie
A
Gauthier
Martha L
ML
McKinney
Pierre
P
Ernst
Johanne
J
Collin
Francine M
FM
Ducharme
D001249:Asthma / Q000628:therapy*; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011792:Quebec; D012648:Self Care; D013038:Specialization; D057170:Translational Research, Biomedical / Q000379:methods*