Provider Perspectives on the Implementation of an Evidence-Based Acute Asthma Pathway in the Pediatric Primary Care Setting

Abstract

Background: Standardized acute care asthma pathways are associated with improved asthma outcomes in emergency department and inpatients settings. We developed and implemented an ambulatory acute asthma care pathway (the "Pathway") in the pediatric primary care clinic of our academic safety-net hospital.

Objective: To qualitatively assess perceived benefits, disadvantages, facilitators, and barriers associated with use and implementation of this Pathway among pediatric primary care providers.

Methods: We conducted semi-structured interviews with primary care providers to elicit their perspectives about the Pathway. The interview guide, codebook, and analysis were guided by the Promoting Action Research on Implementation in Health Services (PARiHS) framework. Interviews were analyzed to identify themes and subthemes.

Results: Participants included 13 clinicians (attending physicians, nurse practitioners, and resident trainees). Major themes included: 1) Providers appreciate standardization of care facilitated by the Pathway and perceive the Pathway as promoting evidence-based care; 2) providers' experience managing acute asthma and with electronic order sets affects the way they engage with the Pathway; more data about performance measures would help; 3) the clinical context influences the way providers utilize the Pathway; and 4) providers identified successes of Pathway implementation (i.e., provider meeting presentations, in-clinic support from Asthma Team "champions") as well as opportunities for improvement.

Conclusions: Providers report positive experiences with the Pathway and recognize the benefits of standardized, evidence-based care. Increased feedback about performance and outcomes and strategies to improve usability were proposed as opportunities for optimizing Pathway uptake. Future studies will evaluate the impact of the Pathway on improving clinical outcomes.

Keywords: acute asthma management; clinical pathway; pediatric asthma; primary care; provider perspectives.