Asthma Guideline Adherence: Improvement Needed in Both Specialists, PCPs

Agreement with and adherence to asthma guidelines are higher in specialists than in primary care clinicians, but both groups fall short in several key recommendations, according to the results of a physician survey published in the Journal of Allergy and Clinical Immunology: In Practice.

Researchers assessed clinician-reported adherence with specific guideline recommendations as well as agreement with and self-efficacy to implement guidelines based on the 2007 Guidelines for the Diagnosis and Management of Asthma.

Using the 2012 National Asthma Survey of Physicians, the researchers assessed data from 1412 primary care clinicians and 233 asthma specialists for 4 cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales. The authors compared adherence between the 2 groups of clinicians and used logistic regression models to assess the association of agreement and self-efficacy indices with adherence.

Asthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than primary care clinicians. However, adherence was low in both groups for specific core recommendations, including a written action plan (30.6% and 16.4%, respectively; P <.001), home peak flow monitoring (12.8% and 11.2%, respectively; P =.34), spirometry testing (44.7% and 10.8%, respectively; P <.001), and repeated assessment of inhaler technique (39.7% and 16.8%, respectively; P <.001).

 In primary care clinicians, greater self-efficacy was associated with greater adherence, but in specialists greater self-efficacy was associated with increased odds of spirometry testing. Guideline agreement was not associated with improved adherence in either group.

There were a number of study limitations. Self-reported behaviors are subject to social and recall bias, and low response rates are known to occur in physician surveys. However, the unweighted and weighted response rates for the National Asthma Survey of Physicians were 38% and 28%, respectively.

Reference

Cloutier MM, Salo PM, Akinbami LJ, et al. Clinician agreement, self-efficacy, and adherence with the guidelines for the diagnosis and management of asthma [published online February 3, 2018]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2018.01.018