Asthma Care Guideline Adherence Among Primary Care Clinicians

Adherence to asthma care guidelines was high among pediatricians for assessment and action plan recommendations, according to a study published in the Journal of Asthma.

Researchers analyzed the difference in adherence rates of the Expert Panel Report-3: Guidelines for the Diagnosis and Management of Asthma among primary care clinicians for the components of assessment and monitoring, patient education, control of environmental factors, and pharmacologic treatment. Data on clinician demographics and practice characteristics were collected from the 2012 National Asthma Survey of Physicians: National Ambulatory Medical Care Survey.

Of the 1355 clinicians who participated in the survey, 524 worked in family and general medicine, 196 worked in internal medicine, 302 worked in pediatrics, and 333 worked in community health centers. Overall, 11.6% strongly agreed with the guidelines,

• 29.6% strongly agreed that action plans are effective,
• 35.4% believed spirometry is necessary for diagnosis,
• 48.1% strongly believed in the use of inhaled corticosteroids,
• 48.5% strongly supported 6-month follow-ups, and
• 50.1% used severity to determine treatment.

In regards to self-efficacy with the guidelines, 20% of family and general medicine clinicians reported high self-efficacy, 35.8% of internal medicine clinicians reported high self-efficacy, 12.6% of pediatric clinicians reported high self-efficacy, and 8.7% of community health center clinicians reported high self-efficacy. In the component of assessment and monitoring, pediatric clinicians were more likely to assess daytime symptoms (71.6%), nighttime waking (70%), and ability to engage in normal activities (63.1%). All groups reported low use of a control assessment tool (20.6%; P <.05, for all).

In the component of patient education, 26.8% of pediatric clinicians reported proving an asthma action plan, which is higher than any other clinician type. In the component of controlling for environmental factors, internal medicine clinicians were most likely to assess asthma triggers at school or work (45.3%). In the component of pharmacologic treatment, all clinicians prescribed inhaled corticosteroids (84%-90.7%).

Limitations of this study include a potential recall bias due to the self-reporting nature of the surveys, the inability to collect data on patient characteristics, and comparing pediatric and adult clinicians on the same components when their treatment structure is different.

The researchers concluded adherence to the guidelines was more common in pediatric medicine and there was a “higher adherence to guideline recommendations among all groups that could be considered ‘low hanging fruit’ — those involving history taking. Recommendations requiring additional equipment, training and patient education had lower rates of high adherence.”

Reference

Akinbami LJ, Salo PM, Cloutier MM, et al. Primary care clinician adherence with asthma guidelines: the National Asthma Survey of Physicians [published online March 1, 2019]. J Asthma. doi: 10.1080/02770903.2019.1579831