Primary care clinician adherence with asthma guidelines: the National Asthma Survey of Physicians

Akinbami, Lara J.; Salo, Päivi M.; Cloutier, Michelle M.; Wilkerson, Jesse; Elward, Kurt; Mazurek, Jacek M.; Williams, Sonja; Zeldin, Darryl C.

doi:10.1080/02770903.2019.1579831

Cited by 47 publications

(25 citation statements)

References 32 publications

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“…In parallel, it is the focus of intensive research that leads to continuous change to clinical practice guidelines and practice, increasingly incorporating precision medicine interventions [21,132]. As a result, implementation of asthma guidelines and delivery of high-quality, evidence-based medicine is challenging and often suboptimal [133][134][135]. Our findings suggest that continuous multifaceted quality improvement processes can enhance adherence to guidelines.…”

Section: Implications For Practice and Researchmentioning

confidence: 89%

ERS/EAACI statement on adherence to international adult asthma guidelines

et al. 2021

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Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.

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Section: Implications For Practice and Researchmentioning

confidence: 89%

ERS/EAACI statement on adherence to international adult asthma guidelines

et al. 2021

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“…PEF self-monitoring has been shown to reduce asthma exacerbations through the development of asthma awareness and control [ 10 – 12 ]. However, despite the international asthma guidelines recommendations for its adoption in poor symptoms perceivers and those with difficult to control asthma, few physicians educate and recommend PEF monitoring to their patients [ 27 , 28 ]. Two of the reasons for clinicians’ low advocacy for peak flow meter use are the wide intraindividual variability in PEF values [ 29 ] and the low adherence to their use, particularly in pediatric patients with asthma.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study

Chelabi¹,

Balli²,

Bransi³

et al. 2021

JMIR Serious Games

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Background International asthma guidelines recommend the monitoring of peak expiratory flow (PEF) as part of asthma self-management in children and adolescents who poorly perceive airflow obstruction, those with a history of severe exacerbations, or those who have difficulty controlling asthma. Measured with a peak flow meter, PEF represents a person’s maximum speed of expiration and helps individuals to follow their disease evolution and, ultimately, to prevent asthma exacerbations. However, patient adherence to regular peak flow meter use is poor, particularly in pediatric populations. To address this, we developed an interactive tablet-based game with a portable game controller that can transduce a signal from the user’s breath to generate a PEF value. Objective The purpose of this study was to evaluate the concordance between PEF values obtained with the game controller and various measures derived from conventional pulmonary function tests (ie, spirometry) and to synthesize the participants’ feedback. Methods In this cross-sectional multicenter study, 158 children (aged 8-15 years old) with a diagnosis or suspicion of asthma performed spirometry and played the game in one of two hospital university centers. We evaluated the correlation between PEF measured by both the game controller and spirometry, forced expiratory volume at 1 second (FEV1), and forced expiratory flow at 25%-75% of pulmonary volume (FEF25-75), using Spearman correlation. A Bland-Altman plot was generated for comparison of PEF measured by the game controller against PEF measured by spirometry. A post-game user feedback questionnaire was administered and analyzed. Results The participants had a mean age of 10.9 (SD 2.5) years, 44% (71/158) were female, and 88% (139/158) were White. On average, the pulmonary function of the participants was normal, including FEV1, PEF, and FEV1/forced vital capacity (FVC). The PEF measured by the game controller was reproducible in 96.2% (152/158) of participants according to standardized criteria. The PEF measured by the game controller presented a good correlation with PEF measured by spirometry (r=0.83, P<.001), with FEV1 (r=0.74, P<.001), and with FEF25-75 (r=0.65, P<.001). The PEF measured by the game controller presented an expected mean bias of –36.4 L/min as compared to PEF measured by spirometry. The participants’ feedback was strongly positive, with 78.3% (123/157) reporting they would use the game if they had it at home. Conclusions The game controller we developed is an interactive tool appreciated by children with asthma, and the PEF values measured by the game controller are reproducible, with a good correlation to values measured by conventional spirometry. Future studies are necessary to evaluate the clinical impact this novel tool might have on asthma management and its potential use in an out-of-hospital setting.

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“…There is variation between healthcare systems in the delivery of asthma care: by primary healthcare providers in some countries, and by specialists in others (9). Moreover, recent studies showed that there is variation in quality of asthma care, adherence to guidelines, and services across asthma specialists and primary care clinicians (37)(38)(39)(40). Further, a recent study showed that Swedish adults with severe asthma had few regular visits with both primary and specialist care (41).…”

Section: Discussionmentioning

confidence: 99%

Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma

et al. 2019

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Objective: Asthma is a multifaceted disease, and severe asthma is likely to be persistent. Patients with severe asthma have the greatest burden and require more healthcare resources than those with mild-to-moderate asthma. The majority with asthma can be managed in primary care, while some patients with severe asthma warrant referral for expert advice regarding management. In adolescence, this involves a transition from pediatric to adult healthcare. This study aimed to explore how young adults with severe asthma experienced the transition process. Methods: Young adults with severe asthma were recruited from an ongoing Swedish population-based cohort. Qualitative data were obtained through individual interviews (n ¼ 16, mean age 23.4 years), and the transcribed data were analyzed with systematic text condensation. Results: Four categories emerged based on the young adults' experiences: "I have to take responsibility", "A need of being involved", "Feeling left out of the system", and "Lack of engagement". The young adults felt they had to take more responsibility, did not know where to turn, and experienced fewer follow-ups in adult healthcare. Further, they wanted healthcare providers to involve them in self-management during adolescence, and in general, they felt that their asthma received insufficient support from healthcare providers. Conclusions: Based on how the young adults with severe asthma experienced the transition from pediatric to adult healthcare, it is suggested that healthcare providers together with each patient prepare, plan, and communicate in the transition process for continued care in line with transition guidelines.

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Primary care clinician adherence with asthma guidelines: the National Asthma Survey of Physicians

Cited by 47 publications

References 32 publications

ERS/EAACI statement on adherence to international adult asthma guidelines

ERS/EAACI statement on adherence to international adult asthma guidelines

Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study

Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma

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