Explaining the amount and consistency of medical care and self-management support in asthma

a survey of primary care providers in France and the United Kingdom

Marijn de Bruin (Corresponding Author), Alexandra L Dima, Nathalie Texier, Eric van Ganse, ASTRO-LAB group

Research output: Contribution to journalArticle

1 Citation (Scopus)
4 Downloads (Pure)

Abstract

BACKGROUND: The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.

OBJECTIVES: To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.

METHODS: An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.

RESULTS: On average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support -but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.

CONCLUSIONS: Using carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.

Original languageEnglish
Pages (from-to)1916-1925
Number of pages10
JournalThe journal of allergy and clinical immunology. In practice
Volume6
Issue number6
Early online date9 May 2018
DOIs
Publication statusPublished - 2018

Fingerprint

Self Care
France
Primary Health Care
Asthma
Delivery of Health Care
Nurses
United Kingdom
Surveys and Questionnaires
Quality of Health Care
Psychometrics
Health Services
Regression Analysis
Guidelines

Keywords

  • Journal Article
  • health care providers, (HCPs)
  • United Kingdom, (UK)
  • Theory of Planned Behaviour, (TPB)
  • Mokken Scaling Analyses, (MSA)
  • Quality Outcomes Framework, (QOF)

Cite this

@article{22402c9f403a4381a9fdca66d549020a,
title = "Explaining the amount and consistency of medical care and self-management support in asthma: a survey of primary care providers in France and the United Kingdom",
abstract = "BACKGROUND: The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.OBJECTIVES: To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.METHODS: An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.RESULTS: On average, HCPs reported delivering 74,2{\%} of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support -but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.CONCLUSIONS: Using carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.",
keywords = "Journal Article, health care providers, (HCPs), United Kingdom, (UK), Theory of Planned Behaviour, (TPB), Mokken Scaling Analyses, (MSA), Quality Outcomes Framework, (QOF)",
author = "{de Bruin}, Marijn and Dima, {Alexandra L} and Nathalie Texier and {van Ganse}, Eric and {ASTRO-LAB group}",
note = "Copyright {\circledC} 2018. Published by Elsevier Inc.",
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language = "English",
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pages = "1916--1925",
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T1 - Explaining the amount and consistency of medical care and self-management support in asthma

T2 - a survey of primary care providers in France and the United Kingdom

AU - de Bruin, Marijn

AU - Dima, Alexandra L

AU - Texier, Nathalie

AU - van Ganse, Eric

AU - ASTRO-LAB group

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018

Y1 - 2018

N2 - BACKGROUND: The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.OBJECTIVES: To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.METHODS: An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.RESULTS: On average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support -but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.CONCLUSIONS: Using carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.

AB - BACKGROUND: The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.OBJECTIVES: To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.METHODS: An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.RESULTS: On average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support -but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.CONCLUSIONS: Using carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.

KW - Journal Article

KW - health care providers, (HCPs)

KW - United Kingdom, (UK)

KW - Theory of Planned Behaviour, (TPB)

KW - Mokken Scaling Analyses, (MSA)

KW - Quality Outcomes Framework, (QOF)

U2 - 10.1016/j.jaip.2018.04.039

DO - 10.1016/j.jaip.2018.04.039

M3 - Article

VL - 6

SP - 1916

EP - 1925

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 6

ER -