Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey.
Agreement
Asthma treatment plan
Inhaler technique
NAEPP
Self-efficacy
Spirometry
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
18
11
2019
revised:
20
03
2020
accepted:
09
04
2020
pubmed:
29
4
2020
medline:
15
5
2021
entrez:
29
4
2020
Statut:
ppublish
Résumé
Little is known about specialist-specific variations in guideline agreement and adoption. To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
Sections du résumé
BACKGROUND
Little is known about specialist-specific variations in guideline agreement and adoption.
OBJECTIVE
To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report.
METHODS
Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time).
RESULTS
Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing.
CONCLUSIONS
Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
Identifiants
pubmed: 32344187
pii: S2213-2198(20)30377-9
doi: 10.1016/j.jaip.2020.04.026
pmc: PMC7554121
mid: NIHMS1587876
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3011-3020.e2Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Organisme : Intramural NIH HHS
ID : Z01 ES025041
Pays : United States
Informations de copyright
Published by Elsevier Inc.
Références
Mayo Clin Proc. 2008 Jul;83(7):786-93
pubmed: 18613995
West J Med. 1997 Dec;167(6):398-407
pubmed: 9426478
Am J Med. 2005 Dec;118 Suppl 12A:36-41
pubmed: 16356806
BMJ Open Diabetes Res Care. 2017 Aug 11;5(1):e000406
pubmed: 28878936
Pediatr Pulmonol. 2007 Apr;42(4):348-56
pubmed: 17352397
Am J Prev Med. 2001 Jan;20(1):61-7
pubmed: 11137777
Am J Med. 2015 May;128(5):502-8
pubmed: 25554370
Pulm Pharmacol Ther. 2017 Jun;44:83-87
pubmed: 28341462
J Allergy Clin Immunol. 2005 Dec;116(6):1307-13
pubmed: 16337464
Adv Med Educ Pract. 2014 May 08;5:141-7
pubmed: 24868181
Vital Health Stat 2. 2018 Aug;(175):1-22
pubmed: 30248016
J Asthma. 2014 May;51(4):429-34
pubmed: 24304046
J Allergy Clin Immunol. 2011 Jul;128(1):56-63
pubmed: 21531451
Paediatr Respir Rev. 2018 Jan;25:85-87
pubmed: 27091766
J Gen Intern Med. 1999 Aug;14(8):499-511
pubmed: 10491236
J Allergy Clin Immunol Pract. 2014 May-Jun;2(3):306-12.e5
pubmed: 24811022
J Asthma. 2004;41(3):343-8
pubmed: 15260468
Allergy Asthma Proc. 2012 Jan-Feb;33(1):54-64
pubmed: 22309716
J Clin Epidemiol. 2010 Jul;63(7):728-36
pubmed: 20346625
J Allergy Clin Immunol Pract. 2018 May - Jun;6(3):886-894.e4
pubmed: 29408439
Pediatrics. 2000 May;105(5):1029-35
pubmed: 10790458