Michelle M Cloutier1, Lara J Akinbami2, Paivi M Salo3, Michael Schatz4, Tregony Simoneau5, Jesse C Wilkerson6, Gregory Diette7, Kurtis S Elward8, Anne Fuhlbrigge9, Jacek M Mazurek10, Lydia Feinstein11, Sonja Williams12, Darryl C Zeldin3. 1. Department of Pediatrics, UCONN Health Farmington, Farmington, Conn. 2. 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. 3. Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC. 4. Department of Allergy, Kaiser Permanente, San Diego Medical Center, San Diego, Calif. 5. Department of Pediatrics, Harvard Medical School, Cambridge, Mass. 6. Social & Scientific Systems, Durham, NC. 7. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md. 8. Department of Family Medicine and Population Health, The Virginia Commonwealth University, Richmond, Va. 9. University of Colorado, School of Medicine, Aurora, Colo. 10. National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WVa. 11. Social & Scientific Systems, Durham, NC; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. 12. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
Abstract
BACKGROUND: Little is known about specialist-specific variations in guideline agreement and adoption. OBJECTIVE: To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. METHODS: Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). RESULTS: Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. CONCLUSIONS: Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake. Published by Elsevier Inc.
BACKGROUND: Little is known about specialist-specific variations in guideline agreement and adoption. OBJECTIVE: To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. METHODS: Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). RESULTS: Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. CONCLUSIONS: Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake. Published by Elsevier Inc.
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