Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Primary-Care Physicians

Grant, Evalyn N.; Moy, James N.; Turner-Roan, Karen; Daugherty, Steven R.; Weiss, Kevin B.

doi:10.1378/chest.116.suppl_2.145s

Cited by 53 publications

(40 citation statements)

References 16 publications

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“…7,14 The impact of the NAEPP guidelines in the primary care community has been less than optimal; 2 surveys that examined the adherence of PCPs to components of the NAEPP guidelines found that a high proportion (Ͼ88%) of physicians had heard of the guidelines and that many (ϳ70%) had read them. 27,28 However, obvious gaps existed in the physicians' promotion of patient self-management practices; for example, less than half were providing written asthma-management plans, a finding that is concordant with results of our study. Reasons cited for this noncompliance include barriers in adopting the practices (lack of time/resources), disagreement with the guidelines, and belief that the recommendations are too rigid.…”

Section: Discussionsupporting

confidence: 87%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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Section: Discussionsupporting

confidence: 87%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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“…Physicians' knowledge was not a barrier to adherence, because most physicians were aware of and had access to the asthma guidelines. [24][25][26] Physicians were not familiar with all of the guidelines' recommendations, mainly because the physicians thought that the presentation of information was poor and the guideline descriptions were tedious, repetitive, and unclear. 27 Physicians disagreed about the categories used to describe patients, the timeliness of therapeutic recommendations, and the "stepwise" and simplistic nature of the guidelines.…”

Section: Dissemination Of Earlier National Asthma Guidelinesmentioning

confidence: 99%

“…27 Other studies of physicians focused on the guidelines' clinical recommendations. [25][26][27][28] Approximately 50% of pediatricians adhered to the NAEPP recommendations for prescription of corticosteroids. 25 Barriers to prescription of daily corticosteroid treatment included physicians' concerns regarding long-term effects of inhaled corticosteroids, such as growth delay, cushingoid effects, and osteoporosis.…”

Section: Dissemination Of Earlier National Asthma Guidelinesmentioning

confidence: 99%

“…More than 90% of physicians would refer a patient who had a life-threatening asthma event, atypical asthma, or severe persistent asthma; however, 40% of physicians would refer a patient who had 2 exacerbations necessitating oral corticosteroid treatment, which is an indication that should prompt referral, according to the NAEPP guidelines. 24,26 Studies examining physician compliance with the NAEPP guidelines' diagnostic criteria for a child with asthma also yielded varied results. Rates of objective measurement of lung function (eg, spirometry) were low, compared with guideline recommendations.…”

Section: Dissemination Of Earlier National Asthma Guidelinesmentioning

confidence: 99%

“…28 Similarly, a survey in Chicago, Illinois, reported spirometry rates of 55% and chest radiography rates of 54% among patients with new asthma diagnoses, although the latter is not recommended routinely. 26 These studies also showed low rates of compliance with recommendations for written asthma treatment plans and routine follow-up visits. 24 In the aforementioned Chicago study, physicians reported developing a written treatment plan for 48% of their patients with moderate/severe persistent asthma, although the majority of physicians did schedule regular follow-up visits.…”

Section: Dissemination Of Earlier National Asthma Guidelinesmentioning

confidence: 99%

See 2 more Smart Citations

The 2007 National Asthma Education and Prevention Program Asthma Guidelines: Accelerating Their Implementation and Facilitating Their Impact on Children With Asthma

Gupta

Weiss

2009

Pediatrics

Self Cite

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Nearly 2 decades have elapsed since the National Center for Health Statistics raised concerns regarding the trends in increasing asthma prevalence. Additional research highlighted the large racial disparities and geographic variations in asthma morbidity and mortality rates. Although there was little national consensus on the care of children with asthma at the time, there were improvements in the understanding of the mechanisms and treatment of asthma. It was in this context that the National Heart, Lung, and Blood Institute launched the National Asthma Education and Prevention Program, which convened its first panel of experts to create the national consensus clinical practice guidelines on the treatment of asthma. More than 15 years have passed since the publication of those first guidelines and, in August 2007, the National Heart, Lung, and Blood Institute released its newest updates, which are the product of the National Asthma Education and Prevention Program third expert panel. The release of the updated guidelines serves as an occasion to examine important issues regarding the dissemination and clinical implementation of National Asthma Education and Prevention Program guidelines. The goals of this report are to examine the adoption of earlier versions of the National Asthma Education and Prevention Program guidelines and to suggest opportunities for rapid adoption of the newly released guidelines.

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Computer-Based Applications in the Management of Asthma

Shegog

Sockrider²

2009

Asthma, Health and Society

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Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Primary-Care Physicians

Cited by 53 publications

References 16 publications

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

The 2007 National Asthma Education and Prevention Program Asthma Guidelines: Accelerating Their Implementation and Facilitating Their Impact on Children With Asthma

Computer-Based Applications in the Management of Asthma

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