Details:

Alternative Title:
J Allergy Clin Immunol Pract
Publisher's site:
http://dx.doi.org/10.1016/j.jaip.2018.01.018
Personal Author:
Cloutier, Michelle M. ; Salo, Paivi M. ; Akinbami, Lara J. ; Cohn, Richard D. ; Wilkerson, Jesse C. ; ... More +
Cloutier, Michelle M. ; Salo, Paivi M. ; Akinbami, Lara J. ; Cohn, Richard D. ; Wilkerson, Jesse C. ; Diette, Gregory B. ; Williams, Sonja ; Elward, Kurtis S. ; Mazurek, Jacek M. ; Spinner, Jovonni R. ; Mitchell, Tracey A. ; Zeldin, Darryl C. ; Less -
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 four cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; two 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 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 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.
Subject:
[+]
Adherence
Agreement
Article
Asthma Guidelines
Confidence
National Survey
Primary Care
Specialist

Source:
J Allergy Clin Immunol Pract. 6(3):886-894.e4 ;
Pubmed ID:
29408439
Pubmed Central ID:
PMC5948143
Document Type:
Journal Article ;
Funding:
CC999999/Intramural CDC HHS/United States ; Z01 ES025041/ES/NIEHS NIH HHS/United States ; Z01 ES025041-10/NULL/Intramural NIH HHS/United States ;
CC999999/Intramural CDC HHS/United States ; Z01 ES025041/ES/NIEHS NIH HHS/United States ; Z01 ES025041-10/NULL/Intramural NIH HHS/United States ; Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:e0c8e9f518fbcdd0a1989fb02deaa18ccd31c694318575be9340287e8ea78697
File Type:

Supporting Files

• 	NIHMS939583-supplement.docx	docx
  	nihms939583.nxml	xml
  	nihms939583f1.gif	gif
  	nihms939583f1.jpg	jpeg
  	nihms939583f2.gif	gif
  	nihms939583f2.jpg	jpeg

More +