Michelle M Cloutier1, Paivi M Salo2, Lara J Akinbami3, Richard D Cohn4, Jesse C Wilkerson4, Gregory B Diette5, Sonja Williams6, Kurtis S Elward7, Jacek M Mazurek8, Jovonni R Spinner9, Tracey A Mitchell10, Darryl C Zeldin2. 1. Department of Pediatrics, UCONN Health, Farmington, Conn; Connecticut Children's Medical Center, Hartford, Conn. 2. Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC. 3. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md; United States Public Health Service, Rockville, Md. Electronic address: lea8@cdc.gov. 4. Social & Scientific Systems, Durham, NC. 5. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md. 6. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md. 7. Department of Family Medicine and Population Health, the Virginia Commonwealth University, Richmond, Va. 8. National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WVa. 9. Food and Drug Administration, Washington, DC. 10. Environmental Protection Agency, Washington, DC.
Abstract
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Louis-Philippe Boulet; J Mark FitzGerald; Mark L Levy; Alvaro A Cruz; Soren Pedersen; Tari Haahtela; Eric D Bateman Journal: Eur Respir J Date: 2012-01-26 Impact factor: 16.671
Authors: Deidre D Crocker; Stella Kinyota; Gema G Dumitru; Colin B Ligon; Elizabeth J Herman; Jill M Ferdinands; David P Hopkins; Briana M Lawrence; Theresa A Sipe Journal: Am J Prev Med Date: 2011-08 Impact factor: 5.043
Authors: Beverley J Sheares; Robert B Mellins; Emily Dimango; Denise Serebrisky; Yuan Zhang; Michael R Bye; Mark E Dovey; Sami Nachman; Vincent Hutchinson; David Evans Journal: Am J Respir Crit Care Med Date: 2015-06-15 Impact factor: 21.405
Authors: Marjolein Lugtenberg; Judith M Zegers-van Schaick; Gert P Westert; Jako S Burgers Journal: Implement Sci Date: 2009-08-12 Impact factor: 7.327
Authors: Michelle M Cloutier; Lara J Akinbami; Paivi M Salo; Michael Schatz; Tregony Simoneau; Jesse C Wilkerson; Gregory Diette; Kurtis S Elward; Anne Fuhlbrigge; Jacek M Mazurek; Lydia Feinstein; Sonja Williams; Darryl C Zeldin Journal: J Allergy Clin Immunol Pract Date: 2020-04-25
Authors: Lara J Akinbami; Paivi M Salo; Michelle M Cloutier; Jesse C Wilkerson; Kurtis S Elward; Jacek M Mazurek; Sonja Williams; Darryl C Zeldin Journal: J Asthma Date: 2019-03-01 Impact factor: 2.515
Authors: Andrew Menzies-Gow; David J Jackson; Mona Al-Ahmad; Eugene R Bleecker; Francisco de Borja G Cosio Piqueras; Stephen Brunton; Giorgio Walter Canonica; Charles K N Chan; John Haughney; Steve Holmes; Janwillem Kocks; Tonya Winders Journal: Adv Ther Date: 2022-10-17 Impact factor: 4.070
Authors: Christopher S Ambrose; Bradley E Chipps; Wendy C Moore; Weily Soong; Jennifer Trevor; Dennis K Ledford; Warner W Carr; Njira Lugogo; Frank Trudo; Trung N Tran; Reynold A Panettieri Journal: Pragmat Obs Res Date: 2020-07-16
Authors: Ka Pang Chan; Fanny Wai San Ko; Kwun Cheung Ling; Pik Shan Cheung; Lee Veronica Chan; Yu Hong Chan; Yi Tat Lo; Chun Kong Ng; Macy Mei-Sze Lui; Kwok Sang Wilson Yee; Cee Zhung Steven Tseng; Pak Yiu Tse; Mo Lin Maureen Wong; Kah Lin Choo; Wai Kei Lam; Chun Man Wong; Sheng Sheng Ho; Chung Tat Lun; Christopher Kei Wai Lai Journal: Immun Inflamm Dis Date: 2021-03-03