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J Med Toxicol. 2018 Dec;14(4):283-294. doi: 10.1007/s13181-018-0676-2. Epub 2018 Jul 25.

Barriers and Facilitators of Intensivists' Adherence to Hyperinsulinemia-Euglycemia Therapy in the Treatment of Calcium Channel Blocker Poisoning.

Author information

1
Department of Anesthesiology and Critical Care, Université Laval, Québec, Québec, Canada.
2
Centre de Recherche du Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada.
3
Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec, Canada.
4
Department of Anesthesiology and Critical Care, Université Laval, Québec, Québec, Canada. Maude.st-onge@fmed.ulaval.ca.
5
Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec, Canada. Maude.st-onge@fmed.ulaval.ca.
6
Centre antipoison du Québec, CIUSSS Capitale Nationale, Québec, Canada. Maude.st-onge@fmed.ulaval.ca.
7
CHU de Québec Research Center, Population Health and Optimal Health Practices, Université Laval, Québec, Québec, Canada. Maude.st-onge@fmed.ulaval.ca.

Abstract

INTRODUCTION:

Adherence to poison center (PC) recommendations for the management of calcium channel blocker (CCB) poisoning is inconsistent. This study aimed to identify behaviors that determine adherence to hyperinsulinemia-euglycemia therapy (HIET) for CCB poisoning.

METHODS:

Semistructured interviews were conducted involving a convenience sample of 18 intensivists. Interview responses were analyzed using the theoretical domains framework (TDF) to identify relevant domains influencing physician adherence to HIET. Two independent reviewers performed qualitative content analysis of the interview transcripts to identify beliefs influencing decisions to initiate HIET. Initially, beliefs were classified and frequencies reported as being likely to facilitate, likely to decrease, or unlikely to affect adherence. Subsequently, beliefs were linked to a domain within the TDF. Based on the potential impact on physician behavior and frequency of reported behavior, we selected the most relevant domains likely to influence physician adherence to HIET for CCB poisoning.

RESULTS:

Positive beliefs were identified in the following domains: "behavioral regulation" (e.g., algorithm for adjustment of perfusions), "belief about capabilities" (e.g., confidence about being able to manage HIET), "belief about consequences" (e.g., fear of clinical deterioration), and "reinforcement" (e.g., clinical instability). Negative beliefs were identified in the following domains as "nature of behavior" (e.g., preference for vasopressors over HIET) and "environmental context and resources" (e.g., accessing dextrose 50% and increased nurse workload).

CONCLUSION:

This qualitative study identified potential behavioral targets for future implementation strategies to address to improve adherence to HIET.

KEYWORDS:

Adherence; Calcium channel blocker; Cardiotoxicity; Implementation; Knowledge transfer

PMID:
30047044
PMCID:
PMC6242797
[Available on 2019-12-01]
DOI:
10.1007/s13181-018-0676-2

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