Strengthening care teams to improve adherence in cystic fibrosis: a qualitative practice assessment and quality improvement initiative
Authors Gardner AJ, Gray AL, Self S, Wagener JS
Received 16 December 2016
Accepted for publication 7 March 2017
Published 10 April 2017 Volume 2017:11 Pages 761—767
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Allison J Gardner,1 Alice L Gray,2 Staci Self,3 Jeffrey S Wagener4
1Med-IQ, LLC, Baltimore, MD, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 3Division of Pediatric Pulmonology, University of Alabama at Birmingham, Birmingham, AL, 4Department of Pediatrics, University of Colorado Medical School, Aurora, CO, USA
Background: Treatment regimens for patients with cystic fibrosis (CF) are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients’ chronic self-management skills, but there is no uniform method for assessing patients’ adherence to treatment or standard interventions to help patients improve when necessary.
Methods: Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a practice assessment and quality improvement (QI) initiative. The intervention included a baseline practice assessment survey, personalized continuing medical education (CME)-certified Webconferences with expert study faculty, targeted reinforcement of key practice points, and follow-up online survey and telephone interviews to evaluate the benefits and limitations of the intervention.
Results: Responses to the baseline practice assessment survey were received from 50 multidisciplinary care team members representing 10 CF centers. Primary barriers to adherence-related aspects of care in their clinics were motivating patients and caregivers to improve adherence and obtaining accurate information about adherence from patients. At the conclusion of the initiative, participants reported improvements in communication within their care team, implementation of new approaches to asking about adherence, and a renewed commitment to asking patients and caregivers about adherence at each clinic visit.
Conclusion: Structured QI interventions that bring multidisciplinary care teams together to reflect on clinic processes and elicit objective insights from outside faculty have the potential to improve practice patterns related to the assessment and improvement of patient adherence in CF.
Keywords: nonadherence, treatment burden, communication, team-based care
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