Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Quality problem. International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment. Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions. We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation. Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation. Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD=±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P