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Adherence to National Asthma Guidelines Varies by Clinician Group

Published online: February 2, 2018

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Cloutier, and colleagues used recently released data from the 2012 National Asthma Survey of Physicians (NAS) to query clinicians’ opinions, self-efficacy, and self-reported adherence regarding asthma care and key recommendations in the 2007 National Asthma Education and Prevention Program (NAEPP) Expert Panel Report-3 (EPR-3). The NAS was a one-time questionnaire supplement to the National Center for Health Statistic’s National Ambulatory Medical Care Survey (NAMCS) and was the first nationally representative study in the US to comprehensively assess adherence to asthma care recommendations. Data from 1,412 primary care clinicians (pediatricians, internists, family medicine practitioners, Community Health Center physicians, and mid-level practitioners) and 233 asthma specialists (allergists and pulmonologists) were analyzed to understand clinicians’ self-reported adherence and self-efficacy to the four cornerstone components of the guidelines: assessment and monitoring of asthma severity and control, patient education, environmental control, and pharmacologic treatment.

Overall, adherence to the guidelines was higher for asthma specialists than primary care clinicians. Compared to primary care clinicians, a higher percentage of asthma specialists almost always (≥ 75% of the time) assessed all measures of asthma impairment (symptom frequency and control) and risk for adverse outcomes (hospitalizations, ED visits). Low percentages of both specialists and primary care clinicians, however, reported almost always performing spirometry (44.7% and 10.8% respectively) and repeated assessment of inhaler technique (39.7% and 16.8%). Use of Asthma Treatment Plans was also low for both groups (only 30.6% and 16.4% almost always provided written plans). Both groups reported patient concerns about long-term effects of inhaled corticosteroids and confusion on the differences between rescue and controller medications. Asthma specialists were more likely to assess environmental triggers and recommend environmental control measures than primary care clinicians. Both groups recommended avoiding environmental tobacco smoke exposure. Medication prescriptions for both groups were consistent with EPR-3 recommendations with specialists using a broader variety of asthma controller medications than primary care clinicians. Among primary care clinicians, greater adherence to the guidelines was associated with greater self-efficacy. Guideline agreement was generally not associated with adherence. Results from this study demonstrate notable differences in guideline agreement, adherence, and implementation among asthma care clinicians. Agreement and adherence to the EPR-3 guidelines are higher for specialists than primary care clinicians, and lower for both groups for several key recommendations, indicating that greater emphasis on guideline adherence is needed. Future research and implementation strategies are needed, including those that are clinician group-specific and those that focus on recommendations that are currently not embraced by either clinician group.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.