Understanding factors that contribute to variations in bronchiolitis management in acute care settings: a qualitative study in Australia and New Zealand using the Theoretical Domains Framework.

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dc.citation.issue1
dc.citation.volume20
dc.contributor.authorHaskell L
dc.contributor.authorTavender EJ
dc.contributor.authorWilson C
dc.contributor.authorBabl FE
dc.contributor.authorOakley E
dc.contributor.authorSheridan N
dc.contributor.authorDalziel SR
dc.contributor.authorPaediatric Research in Emergency Departments International Collaborative (PREDICT) nectwork, Australia
dc.date.available2020-05-01
dc.date.available2020-04-20
dc.date.issued1/05/2020
dc.descriptionPublished source must be acknowledged
dc.description.abstractBACKGROUND: Bronchiolitis is the most common reason for infants under one year of age to be hospitalised. Despite management being well defined with high quality evidence of no efficacy for salbutamol, adrenaline, glucocorticoids, antibiotics or chest x-rays, substantial variation in practice occurs. Understanding factors that influence practice variation is vital in order to tailor knowledge translation interventions to improve practice. This study explores factors influencing the uptake of five evidence-based guideline recommendations using the Theoretical Domains Framework. METHODS: Semi-structured interviews were undertaken with clinicians in emergency departments and paediatric inpatient areas across Australia and New Zealand exploring current practice, and factors that influence this, based on the Theoretical Domains Framework. Interview transcripts were coded using thematic content analysis. RESULTS: Between July and October 2016, 20 clinicians (12 doctors, 8 nurses) were interviewed. Most clinicians believed chest x-rays were not indicated and caused radiation exposure (beliefs about consequences). However, in practice their decisions were influenced by concerns about misdiagnosis, severity of illness, lack of experience (knowledge) and confidence in managing infants with bronchiolitis (skills), and parental pressure influencing practice (social influences). Some senior clinicians believed trialling salbutamol might be of benefit for some infants (beliefs about consequences) but others strongly discounted this, believing salbutamol to be ineffective, with high quality evidence supporting this (knowledge). Most were concerned about antibiotic resistance and did not believe in antibiotic use in infants with bronchiolitis (beliefs about consequences) but experienced pressure from parents to prescribe (social influences). Glucocorticoid use was generally believed to be of no benefit (knowledge) with concerns surrounding frequency of use in primary care, and parental pressure (social influences). Nurse's reinforced evidence-based management of bronchiolitis with junior clinicians (social/professional role and identity). Regular turnover of medical staff, a lack of 'paediatric confident' nurses and doctors, reduced senior medical coverage after hours, and time pressure in emergency departments were factors influencing practice (environmental context and resources). CONCLUSIONS: Factors influencing the management of infants with bronchiolitis in the acute care period were identified using the Theoretical Domains Framework. These factors will inform the development of tailored knowledge translation interventions.
dc.description.publication-statusPublished
dc.identifierhttp://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000531281000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=c5bb3b2499afac691c2e3c1a83ef6fef
dc.identifierARTN 189
dc.identifier.citationBMC PEDIATRICS, 2020, 20 (1)
dc.identifier.doi10.1186/s12887-020-02092-y
dc.identifier.eissn1471-2431
dc.identifier.elements-id431897
dc.identifier.harvestedMassey_Dark
dc.identifier.urihttps://hdl.handle.net/10179/16012
dc.publisherBioMed Central Limited
dc.relation.isPartOfBMC PEDIATRICS
dc.subjectBronchiolitis
dc.subjectAcute care
dc.subjectEmergency department
dc.subjectPaediatric
dc.subjectClinical guideline
dc.subjectEvidence-based practice
dc.subjectTheoretical domains framework
dc.subject.anzsrc1114 Paediatrics and Reproductive Medicine
dc.titleUnderstanding factors that contribute to variations in bronchiolitis management in acute care settings: a qualitative study in Australia and New Zealand using the Theoretical Domains Framework.
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/PVC's Office - College of Health
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