Barriers and facilitators to ED physician use of the test and treatment for BPPV.
Identifieur interne : 000107 ( Main/Curation ); précédent : 000106; suivant : 000108Barriers and facilitators to ED physician use of the test and treatment for BPPV.
Auteurs : Kevin A. Kerber ; Jane Forman ; Laura Damschroder ; Steven A. Telian ; Angela Fagerlin ; Patricia Johnson ; Devin L. Brown ; Lawrence C. An ; Lewis B. Morgenstern ; William J. MeurerSource :
- Neurology. Clinical practice [ 2163-0402 ] ; 2017.
Abstract
BACKGROUND
The test and treatment for benign paroxysmal positional vertigo (BPPV) are evidence-based practices supported by clinical guideline statements. Yet these practices are underutilized in the emergency department (ED) and interventions to promote their use are needed. To inform the development of an intervention, we interviewed ED physicians to explore barriers and facilitators to the current use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM).
METHODS
We conducted semi-structured in-person interviews with ED physicians who were recruited at annual ED society meetings in the United States. We analyzed data thematically using qualitative content analysis methods.
RESULTS
Based on 50 interviews with ED physicians, barriers that contributed to infrequent use of DHT/CRM that emerged were (1) prior negative experiences or forgetting how to perform them and (2) reliance on the history of present illness to identify BPPV, or using the DHT but misattributing patterns of nystagmus. Based on participants' responses, the principal facilitator of DHT/CRM use was prior positive experiences using these, even if infrequent. When asked which clinical supports would facilitate more frequent use of DHT/CRM, participants agreed supports needed to be brief, readily accessible, and easy to use, and to include well-annotated video examples.
CONCLUSIONS
Interventions to promote the use of the DHT/CRM in the ED need to overcome prior negative experiences with the DHT/CRM, overreliance on the history of present illness, and the underuse and misattribution of patterns of nystagmus. Future resources need to be sensitive to provider preferences for succinct information and video examples.
DOI: 10.1212/CPJ.0000000000000366
PubMed: 28680765
PubMed Central: PMC5490384
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Kevin A. Kerber<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Barriers and facilitators to ED physician use of the test and treatment for BPPV.</title>
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<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Forman, Jane" sort="Forman, Jane" uniqKey="Forman J" first="Jane" last="Forman">Jane Forman</name>
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<author><name sortKey="Damschroder, Laura" sort="Damschroder, Laura" uniqKey="Damschroder L" first="Laura" last="Damschroder">Laura Damschroder</name>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Telian, Steven A" sort="Telian, Steven A" uniqKey="Telian S" first="Steven A" last="Telian">Steven A. Telian</name>
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<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Fagerlin, Angela" sort="Fagerlin, Angela" uniqKey="Fagerlin A" first="Angela" last="Fagerlin">Angela Fagerlin</name>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Johnson, Patricia" sort="Johnson, Patricia" uniqKey="Johnson P" first="Patricia" last="Johnson">Patricia Johnson</name>
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<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Brown, Devin L" sort="Brown, Devin L" uniqKey="Brown D" first="Devin L" last="Brown">Devin L. Brown</name>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
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<author><name sortKey="An, Lawrence C" sort="An, Lawrence C" uniqKey="An L" first="Lawrence C" last="An">Lawrence C. An</name>
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<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<author><name sortKey="Morgenstern, Lewis B" sort="Morgenstern, Lewis B" uniqKey="Morgenstern L" first="Lewis B" last="Morgenstern">Lewis B. Morgenstern</name>
<affiliation><nlm:affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</nlm:affiliation>
<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Meurer, William J" sort="Meurer, William J" uniqKey="Meurer W" first="William J" last="Meurer">William J. Meurer</name>
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<wicri:noCountry code="subField">Salt Lake City</wicri:noCountry>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The test and treatment for benign paroxysmal positional vertigo (BPPV) are evidence-based practices supported by clinical guideline statements. Yet these practices are underutilized in the emergency department (ED) and interventions to promote their use are needed. To inform the development of an intervention, we interviewed ED physicians to explore barriers and facilitators to the current use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We conducted semi-structured in-person interviews with ED physicians who were recruited at annual ED society meetings in the United States. We analyzed data thematically using qualitative content analysis methods.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Based on 50 interviews with ED physicians, barriers that contributed to infrequent use of DHT/CRM that emerged were (1) prior negative experiences or forgetting how to perform them and (2) reliance on the history of present illness to identify BPPV, or using the DHT but misattributing patterns of nystagmus. Based on participants' responses, the principal facilitator of DHT/CRM use was prior positive experiences using these, even if infrequent. When asked which clinical supports would facilitate more frequent use of DHT/CRM, participants agreed supports needed to be brief, readily accessible, and easy to use, and to include well-annotated video examples.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Interventions to promote the use of the DHT/CRM in the ED need to overcome prior negative experiences with the DHT/CRM, overreliance on the history of present illness, and the underuse and misattribution of patterns of nystagmus. Future resources need to be sensitive to provider preferences for succinct information and video examples.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">28680765</PMID>
<DateRevised><Year>2020</Year>
<Month>09</Month>
<Day>30</Day>
</DateRevised>
<Article PubModel="Print"><Journal><ISSN IssnType="Print">2163-0402</ISSN>
<JournalIssue CitedMedium="Print"><Volume>7</Volume>
<Issue>3</Issue>
<PubDate><Year>2017</Year>
<Month>Jun</Month>
</PubDate>
</JournalIssue>
<Title>Neurology. Clinical practice</Title>
<ISOAbbreviation>Neurol Clin Pract</ISOAbbreviation>
</Journal>
<ArticleTitle>Barriers and facilitators to ED physician use of the test and treatment for BPPV.</ArticleTitle>
<Pagination><MedlinePgn>214-224</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1212/CPJ.0000000000000366</ELocationID>
<Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The test and treatment for benign paroxysmal positional vertigo (BPPV) are evidence-based practices supported by clinical guideline statements. Yet these practices are underutilized in the emergency department (ED) and interventions to promote their use are needed. To inform the development of an intervention, we interviewed ED physicians to explore barriers and facilitators to the current use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM).</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">We conducted semi-structured in-person interviews with ED physicians who were recruited at annual ED society meetings in the United States. We analyzed data thematically using qualitative content analysis methods.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Based on 50 interviews with ED physicians, barriers that contributed to infrequent use of DHT/CRM that emerged were (1) prior negative experiences or forgetting how to perform them and (2) reliance on the history of present illness to identify BPPV, or using the DHT but misattributing patterns of nystagmus. Based on participants' responses, the principal facilitator of DHT/CRM use was prior positive experiences using these, even if infrequent. When asked which clinical supports would facilitate more frequent use of DHT/CRM, participants agreed supports needed to be brief, readily accessible, and easy to use, and to include well-annotated video examples.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Interventions to promote the use of the DHT/CRM in the ED need to overcome prior negative experiences with the DHT/CRM, overreliance on the history of present illness, and the underuse and misattribution of patterns of nystagmus. Future resources need to be sensitive to provider preferences for succinct information and video examples.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kerber</LastName>
<ForeName>Kevin A</ForeName>
<Initials>KA</Initials>
<AffiliationInfo><Affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Forman</LastName>
<ForeName>Jane</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Damschroder</LastName>
<ForeName>Laura</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Telian</LastName>
<ForeName>Steven A</ForeName>
<Initials>SA</Initials>
<AffiliationInfo><Affiliation>University of Michigan Health System (KAK, PJ, DLB, LCA, LBM, WJM), Ann Arbor; Veterans Affairs Ann Arbor Healthcare System (JF, LD), MI; Implementation Pathways, LLC (LD, SAT), Lebanon, NH; VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS) (AF); and University of Utah (AF), Salt Lake City.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Fagerlin</LastName>
<ForeName>Angela</ForeName>
<Initials>A</Initials>
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