Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

The findings from this study complement the work of Osmond and colleagues [6] who surveyed Canadian multidisciplinary ED healthcare professionals regarding their practices, beliefs and barrier to metered-dose inhaler/spacer use. Osmond's findings highlighted that professionals from sites that used and did not use the MDI/spacer had positive beliefs and knowledge about the innovation. Furthermore, physicians from both adopting and non-adopting sites expected equal or enhanced clinical outcomes with MDI/spacer use; however 70% of physicians did not use MDI/spacers for treatment of pediatric asthma exacerbations. Osmond's work highlights the fact that awareness of the benefits of MDI/spacers is not enough to shape adoption process. The findings of our study provide rich detail about the complex array of individual, innovation and practice environment elements that influence this practice change.