Reasons for pediatrician nonadherence to asthma guidelines.
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.


METHODS
Cross-sectional survey.


METHODS
A national random sample of 829 primary care pediatricians.


METHODS
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.
Cabana
M D
MD
Division of Pediatrics, Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, MD, USA. mcabana@med.umich.edu
Rand
C S
CS
Becher
O J
OJ
Rubin
H R
HR
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001249:Asthma / Q000628:therapy*; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D009330:Nebulizers and Vaporizers; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016540:Smoking Cessation
D000305:Adrenal Cortex Hormones