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J Allergy Clin Immunol Pract. 2018 May - Jun;6(3):886-894.e4. doi: 10.1016/j.jaip.2018.01.018. Epub 2018 Feb 3.

Clinician Agreement, Self-Efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma.

Author information

1
Department of Pediatrics, UCONN Health, Farmington, Conn; Connecticut Children's Medical Center, Hartford, Conn.
2
Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
3
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.
4
Social & Scientific Systems, Durham, NC.
5
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md.
6
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
7
Department of Family Medicine and Population Health, the Virginia Commonwealth University, Richmond, Va.
8
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WVa.
9
Food and Drug Administration, Washington, DC.
10
Environmental Protection Agency, Washington, DC.

Abstract

BACKGROUND:

The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines.

OBJECTIVE:

To assess clinician-reported adherence with specific guideline recommendations, as well as agreement with and self-efficacy to implement guidelines.

METHODS:

We analyzed 2012 National Asthma Survey of Physicians data for 1412 primary care clinicians and 233 asthma specialists about 4 cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; 2 overall indices of agreement and self-efficacy were compiled. Adherence was compared between primary care clinicians and asthma specialists. Logistic regression models assessed the association of agreement and self-efficacy indices with adherence.

RESULTS:

Asthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than did primary care clinicians. Adherence was low among both groups for specific core recommendations, including written asthma action plan (30.6% and 16.4%, respectively; P < .001); home peak flow monitoring, (12.8% and 11.2%; P = .34); spirometry testing (44.7% and 10.8%; P < .001); and repeated assessment of inhaler technique (39.7% and 16.8%; P < .001). Among primary care clinicians, greater self-efficacy was associated with greater adherence. For specialists, self-efficacy was associated only with increased odds of spirometry testing. Guideline agreement was generally not associated with adherence.

CONCLUSIONS:

Agreement with and adherence to asthma guidelines was higher for specialists than for primary care clinicians, but was low in both groups for several key recommendations. Self-efficacy was a good predictor of guideline adherence among primary care clinicians but not among specialists.

KEYWORDS:

Adherence; Agreement; Asthma guidelines; Confidence; National Asthma Survey; Primary care; Specialist

PMID:
29408439
PMCID:
PMC5948143
[Available on 2019-05-01]
DOI:
10.1016/j.jaip.2018.01.018

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