Facilitators and barriers to the implementation of the Primary Care Asthma Paediatric Pathway: a qualitative analysis.

Abstract

The aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the Primary Care Asthma Paediatric Pathway. Qualitative semistructured focus groups following a randomised cluster-controlled design. 22 primary care practices in Alberta, Canada. 37 healthcare providers participated in four focus groups to discuss the barriers and facilitators of pathway implementation. An electronic medical record (EMR) based paediatric asthma pathway, online learning modules, in-person training for allied health teams in asthma education, and a clinical dashboard for patient management. Our qualitative findings are organised into three themes using the core constructs of the normalisation process theory: (1) Facilitators of implementation, (2) Barriers to implementation, and (3) Proposed mitigation strategies. Participants were positive about the pathway, and felt it served as a reminder of paediatric guideline-based asthma management, and an EMR-based targeted collection of tools and resources. Barriers included a low priority of paediatric asthma due to few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a workflow that incorporated the pathway. This study demonstrated the barriers and facilitators shaping the asthma pathway implementation. Our findings highlighted that if team support of <i>enrolment</i> (establishing buy-in), <i>legitimisation</i> (ensuring teams see their role in the pathway) and <i>activation</i> (an ongoing plan for sustainability) there may have been greater uptake of the pathway. This study was registered at clinicaltrials.gov on 25 June 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1.