title: Enablers and determinants of the provision of written action plans to patients with asthma: a stratified survey of Canadian physicians.
abstract: Despite national recommendations, most patients with asthma are not given a written action plan . The objectives were to ascertain physicians' endorsement of potential enablers to providing a written action plan, and the determinants and proportion, of physician-reported use of a written action plan. We surveyed 838 family physicians, paediatricians, and emergency physicians in Quebec. The mailed questionnaire comprised 102 questions on asthma management, 11 of which pertained to written action plan and promising enablers. Physicians also selected a case vignette that best corresponded to their practice and reported their management. The survey was completed by 421 (56%) physicians (250 family physicians, 115 paediatricians and 56 emergency physicians); 43 (5.2%) reported providing a written action plan to ≥70% of their asthmatic patients and 126 (30%) would have used a written action plan in the selected vignette. Most (>60%) physicians highly endorsed the following enablers: patients requesting a written action plan, adding a blank written action plan to the chart, receiving a copy of the written action plan completed by a consultant, receiving a monetary compensation for its completion, and having another healthcare professional explain the completed written action plan to patients. Four determinants were significantly associated with providing a written action plan: being a paediatrician (RR:2.1), treating a child (RR:2.0), aiming for long-term asthma control (RR:2.5), and being aware of national recommendations to provide a written action plan to asthmatic patients (RR:2.9). A small minority of Quebec physicians reported providing a written action plan to most of their patients, revealing a huge care gap. Several enablers to improve uptake, highly endorsed by physicians, should be prioritised in future implementation efforts.
  ENCOURAGING DOCTORS TO PROVIDE WRITTEN ACTION PLANS: Changes to practice organization and doctors' perceptions should encourage the provision of written action plans for all asthma patients. International guidelines state that effective long-term treatment of asthma requires educated self-management, regular reviews and provision of a written action plan (WAP). However, many patients have poor asthma control and as few as 30 per cent have a WAP. Fabienne Djandji at the Saint-Justine University Central Hospital in Montreal, Canada, and co-workers conducted a survey of 421 doctors to determine their attitudes and provision of WAPs. Only 5.2 per cent of respondents provided WAPs to patients; those treating children or aiming for long-term asthma control were more likely to do so. The doctors said that incentives to provide WAPs would include requests from patients themselves, being paid to complete WAPs and having extra support from specialists or other health care professionals such as pharmacists.
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada. fabienne.djandji@mail.mcgill.ca.|Department of Family Medicine, McGill University, Montreal, Quebec, Canada. fabienne.djandji@mail.mcgill.ca.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Djandji
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Alexandrine J
authors.initials: AJ
authors.lastname: Lamontagne
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.affiliation: Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.|Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.affiliation: Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada.|Division of Clinical Epidemiology (MUHC) Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.affiliation: Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada.|Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Martha L
authors.initials: ML
authors.lastname: McKinney
authors.affiliation: Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Desplats
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
mesh_terms: D001249:Asthma / Q000628:therapy*; D002170:Canada; D019468:Disease Management; D004282:Documentation; D004635:Emergency Medicine; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'