Primary Care Clinician Adherence with Asthma Guidelines: The National Asthma Survey of Physicians

Details

• Personal Author:
  Akinbami LJ ; Cloutier MM ; Elward KS ; Mazurek JM ; Salo PM ; Wilkerson JC ; Williams S ; Zeldin DC
• Description:
  Background and objectives: Although primary care clinicians provide >60% of U.S. asthma care, no nationally representative study has examined variation in adherence among primary care groups to four cornerstone domains of the Expert Panel Report-3 asthma guidelines: assessment/monitoring, patient education, environmental assessment, and medications. We used the 2012 National Asthma Survey of Physicians: National Ambulatory Medical Care Survey to compare adherence by family/general medicine practitioners (FM/GM), internists, pediatricians and Community Health Center mid-level clinicians (CHC). Methods: Adherence was self-reported (n = 1355 clinicians). Adjusted odds of almost always adhering to each recommendation (>/=75% of the time) were estimated controlling for clinician/practice characteristics, and agreement and self-efficacy with guideline recommendations. Results: A higher percentage of pediatricians adhered to most assessment/monitoring recommendations compared to FM/GM and other groups (e.g. 71.6% [SE 4.0] almost always assessed daytime symptoms versus 50.6% [SE 5.1]-51.1% [SE 5.8], t-test p < 0.05) but low percentages from all groups almost always performed spirometry (6.8% [SE 2.0]-16.8% [SE 4.7]). Pediatricians were more likely to provide asthma action/treatment plans than FM/GM and internists. Internists were more likely to assess school/work triggers than pediatricians and CHC (environmental assessment). All groups prescribed inhaled corticosteroids for daily control (84.0% [SE 3.7]-90.7% [SE 2.5]) (medications). In adjusted analyses, pediatric specialty, high self-efficacy and frequent specialist referral were associated with high adherence. Conclusions: Pediatricians were more likely to report high adherence than other clinicians. Self- efficacy and frequent referral were also associated with adherence. Adherence was higher for history-taking recommendations and lower for recommendations involving patient education, equipment and expertise. [Description provided by NIOSH]
• Subjects:
  Asthma Health Personnel Occupational Health Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Adherence Agreement Author Keywords: Community Health Center Midlevel Clinicians Bronchial Asthma Control/Management Corticosteroids Family Medicine Guidelines Health Care Internal Medicine Pediatrics Physicians Self-efficacy Spirometry Statistical Analysis Surveillance

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• ISSN:
  0277-0903
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; 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:
  57
• Issue:
  5
• NIOSHTIC Number:
  nn:20054943
• Citation:
  J Asthma 2020 May; 57(5):543-555
• Contact Point Address:
  Lara J. Akinbami, MD, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782
• Email:
  lea8@cdc.gov
• Federal Fiscal Year:
  2020
• Peer Reviewed:
  True
• Source Full Name:
  Journal of Asthma
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:214b8028627199fb1dba2b37220600b8e278651667b4c50bd0d8002e9d4f95fdba496814d6a4cde5d529cb9e71e5234f8271a6f3617c24132904e45c08256d7c
• Download URL:
  https://stacks.cdc.gov/view/cdc/217349/cdc_217349_DS1.pdf
• File Type:
  [PDF - 1.79 MB ]