title: Use of written treatment plans for asthma by specialist physicians.
abstract: Few studies have addressed use of written treatment plans (WTPs) for asthma by specialist physicians. The purpose of this study is to characterize the attitudes, beliefs, and self-reported practice behaviors regarding asthma WTP use among specialist physicians. Structured interviews were conducted with pulmonologists and allergists who provide direct patient asthma care in two New York City medical centers. The interview covered five areas: (1) demographic information; (2) experiences with WTPs; (3) reported clinical practice behaviors; (4) factors influencing use of WTPs; and (5) physician-patient communication. Forty-five physicians were eligible to participate in the study. Sixty-eight percent of physicians treated adult patients while 32% were pediatric specialists. Forty-four physicians completed interviews, (response rate of 98%). Eighty-six percent indicated they use WTPs with at least some of their patients (71% of their patients had received a plan from them). Most reported handwriting plans on a blank piece of paper (66%). Most plans were symptom-based (47%) or combined symptoms with peak flow measurement (50%). Most plans supported patient autonomy. More than 80% of physicians believe the use of a WTP improves patient outcomes. The results suggest that asthma specialists in this survey utilize WTPs more frequently than reported in other studies. Physicians encourage patient autonomy and believe asthma self-management by patients improves their outcomes. Controlled studies of the efficacy of asthma management plans are needed to assess the impact of WTPs as used in clinical practice.
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. bjs4@columbia.edu
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Sheares
authors.forename: Yunling
authors.initials: Y
authors.lastname: Du
authors.forename: Tara L
authors.initials: TL
authors.lastname: Vazquez
authors.forename: Robert B
authors.initials: RB
authors.lastname: Mellins
authors.forename: David
authors.initials: D
authors.lastname: Evans
mesh_terms: D000328:Adult; D000486:Allergy and Immunology; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009518:New York; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D015272:Pulmonary Medicine; D012648:Self Care; D011795:Surveys and Questionnaires