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Reasons for pediatrician nonadherence to asthma guidelines
M D Cabana1, C S Rand, O J Becher
1Division of Pediatrics, Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, MD, USA. mcabana@med.umich.edu
Insights
Pediatricians know asthma guidelines but face barriers to adherence. Tailored interventions are needed to overcome challenges like lack of agreement and self-efficacy, improving patient care.
Area of Science:
- Pulmonary Medicine
- Pediatric Healthcare
- Clinical Practice Guidelines
Background:
- The National Heart, Lung, and Blood Institute (NHLBI) developed asthma guidelines in 1997 to enhance asthma care quality.
- These guidelines provide recommendations for managing asthma effectively in pediatric populations.
Purpose of the Study:
- To investigate the barriers hindering physician adherence to the established NHLBI asthma guidelines.
- Identify specific obstacles preventing pediatricians from fully implementing guideline recommendations.
Main Methods:
- A cross-sectional survey was conducted among a national random sample of 829 primary care pediatricians.
- Data collected included self-reported adherence to guideline components, physician demographics, practice characteristics, and perceived barriers.
- Adherence was defined as following a guideline component over 90% of the time.
Main Results:
- The survey achieved a 55% response rate, with most pediatricians aware of and having access to the NHLBI guidelines.
- Self-reported adherence rates ranged from 39% to 53% across different guideline components.
- Significant barriers to adherence were identified, including lack of agreement for corticosteroid prescription and lack of self-efficacy and outcome expectancy for peak flow meter use and smoking cessation counseling.
Conclusions:
- Despite awareness, pediatricians encountered various barriers limiting their adherence to NHLBI asthma guidelines.
- Implementing tailored interventions addressing specific barriers is crucial for improving guideline adherence and optimizing asthma management.
Background:
The 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines include recommendations on how to improve the quality of care for asthma.
Objective:
To identify barriers to physician adherence to the NHLBI guidelines.
Design:
Cross-sectional survey.
Participants:
A national random sample of 829 primary care pediatricians.
Main Outcome Measures:
Self-reported adherence to 4 components of the NHLBI guidelines (steroid prescription, instructing peak flow meter use, screening and counseling patients with asthma for smoking, and screening and counseling parents for smoking). We also collected information on physician demographics, practice characteristics, and possible barriers to adherence. We defined adherence as following a guideline component more than 90% of the time.
Results:
The response rate was 55% (456/829). Most of the responding pediatricians were aware of the guidelines (88%) and reported having access to a copy of the guidelines (81%). Self-reported rates of adherence were between 39% and 53% for the guideline components. After controlling for demographics and other barriers, we found that nonadherence was associated with specific barriers for each guideline component: for corticosteroid prescription, lack of agreement (odds ratio [OR], 6.8; 95% confidence interval [CI], 3.2-14.4); for peak flow meter use, lack of self-efficacy (OR, 3.4; 95% CI, 1.9-6.1) and lack of outcome expectancy (OR, 4.7; 95% CI, 2.5-8.9); and for screening and counseling of patients and parents for smoking, lack of self-efficacy (OR, 3.8; 95% CI, 1.7-6.2 and OR, 2.8; 95% CI, 1.3-5.9, respectively).
Conclusions:
Although pediatricians in this sample were aware of the NHLBI guidelines, a variety of barriers precluded their successful use. To improve NHLBI guideline adherence, tailored interventions that address the barriers characteristic of a given guideline component need to be implemented.
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