Journal
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY
Volume 101, Issue 3, Pages 264-270Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S1081-1206(10)60491-7
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Funding
- Agency for Healthcare Research and Quality [K08 HS013312]
- National Institute on Aging [RO1 HS09973]
- Empire Clinical Research Investigators program, New York State Department of Health
- AGENCY FOR HEALTHCARE RESEARCH AND QUALITY [K08HS013312] Funding Source: NIH RePORTER
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Background: Health care provider adherence to national asthma guidelines is critical in translating evidence-based recommendations into improved outcomes. Unfortunately, provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) guidelines remains low. Objective: To identify barriers to guideline adherence among primary care professionals providing care to inner-city, minority patients with asthma. Methods: We surveyed 202 providers from 4 major general medicine practices in East Harlem in New York, New York. The Study Outcome was self-reported adherence to 5 NHLBI guideline components: inhaled corticosteroid (ICS) use, peak flow (PF) monitoring, action plan use, allergy testing, and influenza vaccination. Potential barriers included lack of agreement with guideline, lack of self-efficacy, lack of outcome expectancy, and external barriers. Results: Most providers reported adhering to the NHLBI guidelines for ICS use (62%) and for influenza vaccinations (73%). Self-reported adherence was 34% for PF monitoring. 9% for asthma action plan use, and 10% for allergy testing. Multivariate analyses showed that self-efficacy was associated with increased adherence to ICS use (odds ratio [OR], 2.8; P =.03) PF monitoring (OR, 2.3; P =.05), action plan use (OR, 4.9; P =.03), and influenza vaccinations (OR. 3.5; P=.05). Conversely, greater expected patient adherence was associated with increased adherence to PF monitoring (OR, 3.3; P=.03) and influenza vaccination (OR, 3.5; P =.01). Familiarity with specific guideline components and higher level of training were also predictors of adherence. Conclusions: Lack Of Outcome expectancy and poor provider self-efficacy prevent providers from adhering to national asthma guidelines. Efforts to improve provider adherence should address these specific barriers.
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