부산대학교 도서관

Brigitte Vachon,1,2 Guylaine Giasson,3 Isabelle Gaboury,3,4 Dina Gaid,1 Véronique Noël De Tilly,5 Lise Houle,6 Jean Bourbeau,7 Marie-Pascale Pomey8,9 1School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 2Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada; 3Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada; 4Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Convergence Santé, Montreal, Québec, Canada; 6Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada; 7Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; 8Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 9Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, CanadaCorrespondence: Brigitte VachonSchool of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email brigitte.vachon@umontreal.caIntroduction: Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec.Methods: Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel.Results: Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals’ education and interprofessional collaboration and communication.Conclusion: QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.Keywords: COPD, quality of care, primary care, quality improvement collaborative, interprofessional collaboration