Quality of care of Egyptian asthmatic children: Clinicians adherence to asthma guidelines

Abstract

BackgroundDespite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice.ObjectivesTo assess the physicians attitude towards asthma guidelines and their adherence to its recommendations.MethodsThree hundred and fifty two clinicians (101 General practitioners, 131 pediatric specialists, 35 pediatric consultants and 85 doctors did not report the qualification) engaged in direct childhood asthma care in Cairo, Egypt were subjected to a self-administered questionnaire with 35 questions of which most were multiple choices, aiming at assessment of three important aspects about the involved physicians; physician's knowledge, practice and attitude. 165 of the clinicians were working in governmental hospitals, 68 clinicians work in private clinics and 119 clinicians work in both.ResultsAgreement with asthma guidelines was present in 76.2% of the studied physicians, however those who not in agreement with the guidelines claimed that this was mainly due to patient factors, firstly the poor socioeconomic standard of the patient (18.1%) and secondly due to poor patient compliance (16%). Poor knowledge was found in 28.5%, poor practice was found in 43.6% and poor attitude was found in 14.4% of the studied physicians. There was positive highly significant correlation between qualification and knowledge, (p < 0.01), positive highly significant correlation between qualification and practice, (p < 0.01), and positive highly significant correlation between qualification and attitude, (p < 0.01).ConclusionThe attitude of the studied physicians revealed agreement of their majority with the guidelines, while the disagreement was mainly explained by the poor socioeconomic standard of the patients. The degree of poor practice is more marked than that of poor knowledge or poor attitude reflecting resources limitations and applications obstacles in the physician's practice.

Knowledge about childhood bronchial asthma among primary health care personnel in eastern Saudi Arabia

“…[19] In the current study, the fact that younger health care personnel and those with less than 5-years experience of work in PHCCs had signifi cantly good knowledge which may possibly be due to their being newly graduated physicians with recent knowledge from their medical school studies. Nurses were still having some defi ciencies in knowledge of bronchial asthma compared to physicians.…”

Medication Use in Children with Asthma: Not a Child Size Problem

“…It has been consistently reported in recent years that combination asthma medications (ICS + LABA) are being overused in pediatric populations, with some case reports of serious adverse events (48,49,71). This may be due to a physician's lack of adherence to guidelines, perhaps compounded by a lack of knowledge, awareness, or familiarity about specific aspects of the disease and its management (43)(44)(45). Nonfacilitative communication by health-care professionals about medicines and asthmarelated information to families is probably due to time constraints (45).…”

“…While several phenotypes in childhood asthma are recognized, few studies have designed specific, phenotype-driven asthma therapy trials in pediatric populations (78)(79)(80) communication is an essential component of pediatric asthma management. Probing, identifying, and addressing parental/carer fears at the start of treatment can help to allay doubts and improve adherence to therapy (44,45,72). Intervention research should concentrate on family-focused interventions designed to promote asthma control by integrating psychosocial factors (62).…”

“…Physician nonadherence to prescribing guidelines was frequently identified (43)(44)(45). Other prescribing concerns included "off-label" prescribing, for example, use of combination inhalers containing ICS and LABA in children under 6 years old.…”

“…Other prescribing concerns included "off-label" prescribing, for example, use of combination inhalers containing ICS and LABA in children under 6 years old. Over/underdiagnosis of asthma by physicians was also identified to be a problem (43)(44)(45)(46)(47)(48)(49)(50)(51)(52). In some studies, working with patients (and parents) from different ethnic backgrounds was associated with a lack of active communication about medications (53).…”