Sande O Okelo1, George K Siberry2, Barry S Solomon3, Andrew L Bilderback4, Michiyo Yamazaki5, Theresa Hetzler6, Cynthia L Ferrell7, Nui Dhepyasuwan8, Janet R Serwint3. 1. Division of Pediatric Pulmonology, The David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: sokelo@mednet.ucla.edu. 2. Pediatric, Adolescent, and Maternal AIDS (PAMA) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md. 3. Division of General Pediatrics & Adolescent Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md. 4. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md. 5. Department of Family, Population and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. 6. Department of Pediatrics, New York Medical College, Valhalla, NY. 7. Department of Pediatrics, Oregon Health & Science University, Portland, Ore. 8. Academic Pediatric Association, McLean, Va.
Abstract
OBJECTIVE: To compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training. METHODS: We conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication. RESULTS: There were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training. CONCLUSIONS: Pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.
OBJECTIVE: To compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training. METHODS: We conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication. RESULTS: There were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training. CONCLUSIONS: Pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.
Authors: Janet R Serwint; Kathleen A Thoma; Sharon M Dabrow; Lynn E Hunt; Michelle S Barratt; Timothy R Shope; Paul M Darden Journal: Pediatrics Date: 2006-08-21 Impact factor: 7.124
Authors: Sande O Okelo; Cecilia M Patino; Kristin A Riekert; Barry Merriman; Andrew Bilderback; Nadia N Hansel; Kathy Thompson; Jennifer Thompson; Ruth Quartey; Cynthia S Rand; Gregory B Diette Journal: Pediatrics Date: 2008-07 Impact factor: 7.124
Authors: Scott D Krugman; Andrew Racine; Sharon Dabrow; Sandra Sanguino; Walter Meyer; Michael Seid; Janet R Serwint Journal: Pediatrics Date: 2007-07-30 Impact factor: 7.124
Authors: Gregory B Diette; Cecilia M Patino; Barry Merriman; Laura Paulin; Kristin Riekert; Sande Okelo; Kathy Thompson; Jerry A Krishnan; Ruth Quartey; Deanna Perez-Williams; Cynthia Rand Journal: Arch Intern Med Date: 2007-07-09