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Journal of Medical Toxicology

, Volume 14, Issue 4, pp 283–294 | Cite as

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

  • Eric Brassard
  • Patrick Archambault
  • Guillaume Lacombe
  • Maude St-OngeEmail author
Original Article

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

Calcium channel blocker Cardiotoxicity Knowledge transfer Implementation Adherence 

Notes

Acknowledgements

We thank all participants who participated in this study. We thank the Canadian Critical Care Society for sharing access to their electronic mailing list of members.

Sources of Funding

None.

Compliance with Ethical Standards

Conflicts of Interest

None.

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Copyright information

© American College of Medical Toxicology 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareUniversité LavalQuébecCanada
  2. 2.Centre de Recherche du Centre intégré en santé et services sociaux de Chaudière-AppalachesLévisCanada
  3. 3.Department of Family Medicine and Emergency MedicineUniversité LavalQuébecCanada
  4. 4.Centre antipoison du QuébecCIUSSS Capitale NationaleQuébecCanada
  5. 5.CHU de Québec Research Center, Population Health and Optimal Health PracticesUniversité LavalQuébecCanada

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