BACKGROUND: Health care provider adherence to national asthma guidelines is critical in translating evidence-based recommendations into improved outcomes. Unfortunately, provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) guidelines remains low. OBJECTIVE: To identify barriers to guideline adherence among primary care professionals providing care to inner-city, minority patients with asthma. METHODS: We surveyed 202 providers from 4 major general medicine practices in East Harlem in New York, New York. The study outcome was self-reported adherence to 5 NHLBI guideline components: inhaled corticosteroid (ICS) use, peak flow (PF) monitoring, action plan use, allergy testing, and influenza vaccination. Potential barriers included lack of agreement with guideline, lack of self-efficacy, lack of outcome expectancy, and external barriers. RESULTS: Most providers reported adhering to the NHLBI guidelines for ICS use (62%) and for influenza vaccinations (73%). Self-reported adherence was 34% for PF monitoring, 9% for asthma action plan use, and 10% for allergy testing. Multivariate analyses showed that self-efficacy was associated with increased adherence to ICS use (odds ratio [OR], 2.8; P = .03), PF monitoring (OR, 2.3; P = .05), action plan use (OR, 4.9; P = .03), and influenza vaccinations (OR, 3.5; P = .05). Conversely, greater expected patient adherence was associated with increased adherence to PF monitoring (OR, 3.3; P = .03) and influenza vaccination (OR, 3.5; P = .01). Familiarity with specific guideline components and higher level of training were also predictors of adherence. CONCLUSIONS: Lack of outcome expectancy and poor provider self-efficacy prevent providers from adhering to national asthma guidelines. Efforts to improve provider adherence should address these specific barriers.
BACKGROUND: Health care provider adherence to national asthma guidelines is critical in translating evidence-based recommendations into improved outcomes. Unfortunately, provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) guidelines remains low. OBJECTIVE: To identify barriers to guideline adherence among primary care professionals providing care to inner-city, minority patients with asthma. METHODS: We surveyed 202 providers from 4 major general medicine practices in East Harlem in New York, New York. The study outcome was self-reported adherence to 5 NHLBI guideline components: inhaled corticosteroid (ICS) use, peak flow (PF) monitoring, action plan use, allergy testing, and influenza vaccination. Potential barriers included lack of agreement with guideline, lack of self-efficacy, lack of outcome expectancy, and external barriers. RESULTS: Most providers reported adhering to the NHLBI guidelines for ICS use (62%) and for influenza vaccinations (73%). Self-reported adherence was 34% for PF monitoring, 9% for asthma action plan use, and 10% for allergy testing. Multivariate analyses showed that self-efficacy was associated with increased adherence to ICS use (odds ratio [OR], 2.8; P = .03), PF monitoring (OR, 2.3; P = .05), action plan use (OR, 4.9; P = .03), and influenza vaccinations (OR, 3.5; P = .05). Conversely, greater expected patient adherence was associated with increased adherence to PF monitoring (OR, 3.3; P = .03) and influenza vaccination (OR, 3.5; P = .01). Familiarity with specific guideline components and higher level of training were also predictors of adherence. CONCLUSIONS: Lack of outcome expectancy and poor provider self-efficacy prevent providers from adhering to national asthma guidelines. Efforts to improve provider adherence should address these specific barriers.
Authors: Xavier Perez; Juan P Wisnivesky; Linda Lurslurchachai; Lawrence C Kleinman; Ian M Kronish Journal: Respir Med Date: 2011-10-13 Impact factor: 3.415
Authors: Sande O Okelo; Arlene M Butz; Ritu Sharma; Gregory B Diette; Samantha I Pitts; Tracy M King; Shauna T Linn; Manisha Reuben; Yohalakshmi Chelladurai; Karen A Robinson Journal: Pediatrics Date: 2013-08-26 Impact factor: 7.124
Authors: Robert S Rudin; Christopher H Fanta; Nabeel Qureshi; Erin Duffy; Maria O Edelen; Anuj K Dalal; David W Bates Journal: Appl Clin Inform Date: 2019-10-16 Impact factor: 2.342
Authors: Sangita P Patil; Juan P Wisnivesky; Paula J Busse; Ethan A Halm; Xiu-Min Li Journal: Ann Allergy Asthma Immunol Date: 2011-01-14 Impact factor: 6.347