title: Impact of the national asthma guidelines on internal medicine primary care and specialty practice.
abstract: OBJECTIVE
  To evaluate documentation of compliance with the National Asthma Education and Prevention Program publication Guidelines for the Diagnosis and Management of Asthma.
  
  
  METHODS
  A retrospective review of 114 charts coded as asthma. Fourteen chart evaluation questions were developed based on the 4 management components in the guidelines: assessment and monitoring of asthma, control of asthma factors, pharmacotherapy, and patient education.
  
  
  METHODS
  A hospital-based asthma clinic, a private pulmonary group, and a general internal medicine group in Dallas, Texas.
  
  
  RESULTS
  Nearly all physicians documented inquiries about daytime asthma symptoms, but only 64% of pulmonary group and 58% of internal medicine physicians documented inquiries about nighttime symptoms. In addition, in 14% of pulmonary group charts and 74% of internal medicine charts, no spirometry or peak flow data were documented. Most asthma clinic and pulmonary group charts (98% and 78%, respectively) included a history of triggers, but the pulmonary group and internal medicine group were more likely to document administration of the influenza vaccine than the asthma clinic (25% and 26% vs 13%). Of 38 patients with > or = 1 recorded forced expiratory volume in 1 second <60%, all but 1 were on inhaled steroids. However, many charts lacked adequate documentation to match drug selection to asthma severity. The asthma clinic group documented the 4 educational interventions 65% to 83% of the time, compared with the pulmonary group, at 17% to 50%, and the internal medicine group, at 5% to 18%.
  
  
  CONCLUSIONS
  Results showed significant variation with the recommendations. Areas in particular need of improvement were objective diagnosis and assessment, control of asthma-associated factors, and patient education. Furthermore, the study demonstrated significant variation between specialists and primary care physicians, with the more specialized clinics demonstrating better guideline compliance.
authors.affiliation: Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas 75246, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Gipson
authors.forename: M W
authors.initials: MW
authors.lastname: Millard
authors.forename: D A
authors.initials: DA
authors.lastname: Kennerly
authors.forename: J
authors.initials: J
authors.lastname: Bokovoy