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Barriers pediatricians face when using asthma practice guidelines.

M D Cabana1, B E Ebel, L Cooper-Patrick

  • 1Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Archives of Pediatrics & Adolescent Medicine
|July 13, 2000
PubMed
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Pediatricians face many barriers to using asthma guidelines, including time limits and lack of agreement. Tailoring interventions to physician experience and guideline type is key for better adherence to National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Practice Guidelines
  • Healthcare Delivery

Background:

  • The 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines aimed to standardize care.
  • Understanding barriers to guideline implementation is crucial for improving asthma management.
  • Pediatricians' perspectives on guideline adherence are essential for effective interventions.

Purpose of the Study:

  • To identify and describe the barriers encountered by pediatricians in adhering to specific recommendations within the 1997 NHLBI asthma guidelines.
  • To explore how recommendation type and physician experience influence perceived barriers.

Main Methods:

  • Conducted 3 focus groups with 21 pediatricians and 1 nurse practitioner.
  • Discussed barriers related to inhaled corticosteroids, peak flowmeter use, smoking cessation, and allergen counseling.

Related Experiment Videos

  • Analyzed 171 comments identifying specific obstacles to guideline adherence.

    • Main Results:

    • Identified 171 distinct barriers to guideline adherence.
    • Physician experience (year of graduation) correlated with specific barriers (e.g., agreement for senior vs. confidence for junior physicians).
    • Time limitations were a universal barrier; inertia of previous practice was noted by senior physicians.

    Conclusions:

    • Adherence barriers include lack of awareness, familiarity, agreement, and external factors (environmental, guideline, patient).
    • Novel barriers identified include lack of self-efficacy, outcome expectancy, and inertia of previous practice.
    • Interventions must be tailored to physician demographics and the specific type of guideline recommendation to enhance NHLBI asthma guideline adherence.