title: Encouraging a systems approach for adherence to national asthma guidelines.
abstract: OBJECTIVE
  There is a lack of information in the literature reflecting systems effects on adherence to national asthma guidelines. The purpose of this pilot study is to provide a descriptive account of the preparedness of academic primary care sites to follow national asthma guidelines related to spirometry, peak flow meters, standard history forms, severity assessment, follow-up assessment sheets, patient self-assessment sheets, and asthma action plan templates.
  
  
  METHODS
  This was a cross-sectional descriptive study. A short survey was mailed to medical directors on behalf of primary care academic clinical sites to assess the availability of guideline tools in their practices. Medical directors were also asked to rate their perception of how essential the guidelines were in the management of asthma.
  
  
  RESULTS
  Medical directors agreed that the guideline tools were essential in managing asthma. However, with the exceptions of peak flow meters and standard history forms, most sites were not equipped with these tools for providers to use.
  
  
  CONCLUSIONS
  The findings highlight the importance of the practice environment on the implementation of national asthma guidelines and encourage larger studies to include an assessment of the systems in place to enable guideline adherence. By taking systems into account, interventions may be potentially much more effective in improving the quality of care.
authors.affiliation: Family Medicine Research Institute, Department of Family Medicine, University at Buffalo, State University of New York, Buffalo, New York 14215, USA. tumiel@buffalo.edu
authors.forename: Laurene M
authors.initials: LM
authors.lastname: Tumiel-Berhalter
authors.forename: Charles O
authors.initials: CO
authors.lastname: Hershey
mesh_terms: D000046:Academic Medical Centers; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D010346:Patient Care Management; D010366:Peak Expiratory Flow Rate; D008486:Physician Executives; D010865:Pilot Projects; D011320:Primary Health Care; D011788:Quality of Life; D012647:Self-Assessment; D013147:Spirometry; D013598:Systems Theory; D014481:United States