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Emergency physicians' prescribing of asthma controller medications
Richard J Scarfone1, Joseph J Zorc, Cherrie J Angsuco
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. scarfone@email.chop.edu
Pediatrics
|March 3, 2006
Summary
Emergency department physicians rarely prescribe long-term controller medications (LTCMs) for children with persistent asthma, despite believing in their efficacy and guidelines. This gap highlights a need to improve asthma management in emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- Asthma is a common chronic respiratory disease in children.
- Long-term controller medications (LTCMs) are crucial for managing persistent asthma.
- Emergency departments (EDs) are frequent points of care for children with asthma exacerbations.
Purpose of the Study:
- To determine the frequency of LTCM prescribing by ED physicians for children with asthma.
- To assess ED physicians' awareness of and adherence to national asthma guidelines.
- To identify barriers to LTCM prescribing in the ED setting.
Main Methods:
- A survey was distributed to physician members of the American Academy of Pediatrics Section on Emergency Medicine.
- The survey focused on the prescribing habits, guideline awareness, and decision-making criteria for LTCMs in pediatric asthma patients.
- Response rate was 50% (391 of 782 physicians).
Main Results:
- 80% of ED physicians reported that less than half of children with persistent asthma arrived at the ED using LTCMs.
- Despite 99% agreeing that persistent asthma requires LTCMs, fewer than 20% prescribed them at ED discharge.
- The primary reason for not prescribing was the belief that it was the role of primary care providers or specialists (49%).
Conclusions:
- ED physicians frequently see children with persistent asthma undertreated with LTCMs.
- Physicians express belief in LTCM efficacy and safety, yet prescribing rates remain low.
- Barriers include perceived provider roles and a lack of emphasis on specific patient factors in prescribing decisions.
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