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Ann Allergy Asthma Immunol. 2008 Sep;101(3):264-70. doi: 10.1016/S1081-1206(10)60491-7.

Barriers to adherence to asthma management guidelines among inner-city primary care providers.

Author information

1
Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. juan.wisnivesky@mssm.edu

Abstract

BACKGROUND:

Health care provider adherence to national asthma guidelines is critical in translating evidence-based recommendations into improved outcomes. Unfortunately, provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) guidelines remains low.

OBJECTIVE:

To identify barriers to guideline adherence among primary care professionals providing care to inner-city, minority patients with asthma.

METHODS:

We surveyed 202 providers from 4 major general medicine practices in East Harlem in New York, New York. The study outcome was self-reported adherence to 5 NHLBI guideline components: inhaled corticosteroid (ICS) use, peak flow (PF) monitoring, action plan use, allergy testing, and influenza vaccination. Potential barriers included lack of agreement with guideline, lack of self-efficacy, lack of outcome expectancy, and external barriers.

RESULTS:

Most providers reported adhering to the NHLBI guidelines for ICS use (62%) and for influenza vaccinations (73%). Self-reported adherence was 34% for PF monitoring, 9% for asthma action plan use, and 10% for allergy testing. Multivariate analyses showed that self-efficacy was associated with increased adherence to ICS use (odds ratio [OR], 2.8; P = .03), PF monitoring (OR, 2.3; P = .05), action plan use (OR, 4.9; P = .03), and influenza vaccinations (OR, 3.5; P = .05). Conversely, greater expected patient adherence was associated with increased adherence to PF monitoring (OR, 3.3; P = .03) and influenza vaccination (OR, 3.5; P = .01). Familiarity with specific guideline components and higher level of training were also predictors of adherence.

CONCLUSIONS:

Lack of outcome expectancy and poor provider self-efficacy prevent providers from adhering to national asthma guidelines. Efforts to improve provider adherence should address these specific barriers.

PMID:
18814449
DOI:
10.1016/S1081-1206(10)60491-7
[Indexed for MEDLINE]

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