Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study.
BACKGROUND
Asthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care.


METHODS
We designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention.


RESULTS
Seven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/- 3.1 pre- to 27.3 +/- 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively.


CONCLUSIONS
A mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.
Department of Medicine, University of Toronto, Toronto, Canada. guptas@smh.ca.|Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, Canada. guptas@smh.ca.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. guptas@smh.ca.|, Suite 6042, Bond Wing, 30 Bond St., M5B 1W8, Toronto, ON, Canada. guptas@smh.ca.
Samir
S
Gupta
Ontario Lung Association, Toronto, Canada.
Dilshad
D
Moosa
Southlake Regional Health Centre, Newmarket, Canada.
Ana
A
MacPherson
Department of Medicine and Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada.
Christopher
C
Allen
Stonegate Community Health Centre, Toronto, Canada.
Itamar E
IE
Tamari
D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D000071252:Mentoring / Q000379:methods*; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D013147:Spirometry / Q000592:standards*; D013997:Time Factors
Asthma; Before-and-after study design; Mentorship; Quality improvement; Spirometry