Clinician Agreement, Self-Efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma

Details

• Personal Author:
  Akinbami LJ ; Cloutier MM ; Cohn RD ; Diette GB ; Elward KS ; Mazurek JM ; Mitchell TA ; Salo PM ; Spinner JR ; Wilkerson JC ; Williams S ; Zeldin DC
• Description:
  BACKGROUND: The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines. OBJECTIVE: To assess clinician-reported adherence with specific guideline recommendations, as well as agreement with and self-efficacy to implement guidelines. METHODS: We analyzed 2012 National Asthma Survey of Physicians data for 1412 primary care clinicians and 233 asthma specialists about 4 cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; 2 overall indices of agreement and self-efficacy were compiled. Adherence was compared between primary care clinicians and asthma specialists. Logistic regression models assessed the association of agreement and self-efficacy indices with adherence. RESULTS: Asthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than did primary care clinicians. Adherence was low among both groups for specific core recommendations, including written asthma action plan (30.6% and 16.4%, respectively; P < .001); home peak flow monitoring, (12.8% and 11.2%; P = .34); spirometry testing (44.7% and 10.8%; P < .001); and repeated assessment of inhaler technique (39.7% and 16.8%; P < .001). Among primary care clinicians, greater self-efficacy was associated with greater adherence. For specialists, self-efficacy was associated only with increased odds of spirometry testing. Guideline agreement was generally not associated with adherence. CONCLUSIONS: Agreement with and adherence to asthma guidelines was higher for specialists than for primary care clinicians, but was low in both groups for several key recommendations. Self-efficacy was a good predictor of guideline adherence among primary care clinicians but not among specialists. [Description provided by NIOSH]
• Subjects:
  Asthma Education Occupational Health Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Agreement Asthma Guidelines Author Keywords: Adherence Bronchial Asthma Confidence Environmental Control Guidelines Health Care Models National Asthma Survey Primary Care Specialist Spirometry Statistical Analysis Surveillance

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• ISSN:
  2213-2198
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; District of Columbia ; Maryland ; North Carolina ; OSHA Region 1 ; OSHA Region 3 ; OSHA Region 4 ; Virginia ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  6
• Issue:
  3
• NIOSHTIC Number:
  nn:20051215
• Citation:
  J Allergy Clin Immunol Pract 2018 May/Jun; 6(3):886-894.e4
• Contact Point Address:
  Lara J. Akinbami, MD, National Center for Health Statistics, 3311 Toledo Rd, Hyattsville, MD 20782
• Email:
  lea8@cdc.gov
• Federal Fiscal Year:
  2018
• Peer Reviewed:
  True
• Source Full Name:
  Journal of Allergy and Clinical Immunology: In Practice
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6ce52486317e48fabf08097e83698377a834becb7cbb446b7097e0d406017dfebfb6d3aad07a3822f972183ba070a0fe789bec7c2d1372f7afccff8dc6335045
• Download URL:
  https://stacks.cdc.gov/view/cdc/211293/cdc_211293_DS1.pdf
• File Type:
  [PDF - 350.49 KB ]