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Specialty differences in prescribing inhaled corticosteroids for children
Michael D Cabana1, Heba Abu-Isa, Shannon M Thyne
1Department of Pediatrics, University of California, San Francisco, California 94118, USA. michael.cabana@ucsf.edu
Clinical Pediatrics
|May 16, 2007
Summary
Daily inhaled corticosteroid prescriptions for children with persistent asthma are often below guidelines. Physician agreement with guidelines and fewer practice barriers significantly improve adherence to asthma treatment recommendations.
Area of Science:
- Pediatric Pulmonology
- General Pediatrics
- Primary Care Medicine
Background:
- National guidelines recommend daily inhaled corticosteroids (ICS) for persistent childhood asthma.
- Current prescription rates for ICS in children with persistent asthma are lower than recommended.
- Understanding physician-reported barriers is crucial for improving adherence to asthma management guidelines.
Purpose of the Study:
- To identify differences in adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines for ICS prescribing between pediatricians and family physicians.
- To determine factors associated with physician adherence to ICS prescribing guidelines.
- To explore specialty-specific barriers to ICS utilization in pediatric asthma care.
Main Methods:
- A national, cross-sectional survey was conducted among pediatricians and family physicians.
- Physician adherence was defined as prescribing ICS according to guidelines for >90% of eligible patients.
- Multivariate logistic regression analysis was used to identify factors associated with adherence.
Main Results:
- Overall adherence rates were similar between pediatricians (54%) and family physicians (51%).
- Common barriers included parent hesitancy, but family physicians more frequently cited medication cost, while pediatricians cited lack of time.
- Lack of practice/family barriers and agreement with NHLBI recommendations were significantly associated with higher adherence.
Conclusions:
- Interventions to enhance ICS prescribing for pediatric persistent asthma require tailored strategies addressing unique barriers faced by pediatricians and family physicians.
- Addressing perceived medication costs and time constraints may improve guideline adherence.
- Physician agreement with established guidelines is a key factor in promoting optimal asthma management.
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