What constitutes maintenance asthma care? The pediatrician's perspective.
OBJECTIVE
To describe how pediatricians report they provide maintenance care for children with persistent asthma, and to identify opportunities for improvement.


METHODS
An anonymous 34-item survey was completed by community pediatricians in St Louis, Missouri, between June 2005 and October 2005. Physicians reported the percentage of patients for whom they would prescribe inhaled corticosteroids, and selected from checklists the activities and questions they would use during a maintenance care visit.


RESULTS
A total of 135 (60%) of 225 eligible pediatricians responded. Respondents reported they prescribed inhaled corticosteroids for most patients (median 80% patients, range, 10%-100%). Although most respondents used specific questions to assess recent asthma burden including inquiring about the frequency of daytime (86%) and nighttime (83%) symptoms, fewer asked about activity limitations such as school absences (58%). Some reported using specific questions to assess medication adherence such as how often doses were missed (49%), or included collaborative activities to support daily self-management such as setting asthma care goals (60%), but fewer asked how symptoms were monitored (44%) or assessed the effect of the child's asthma on the parent and family (24%).


CONCLUSIONS
Findings from this self-reported physician survey suggest that asthma management practices fall short of optimal standards. Opportunities for improvement include more comprehensive and detailed assessment of asthma control and medication adherence, collaborative goal setting, and better collaboration with the parent to support effective self-management. Further interventions to reduce asthma morbidity need to support physicians with these activities.
Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA. jgarbutt@im.wustl.edu
Jane
J
Garbutt
Gordon
G
Bloomberg
Christina
C
Banister
Randall
R
Sterkel
Jay
J
Epstein
Julie
J
Bruns
Lisa
L
Swerczek
Suzanne
S
Wells
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000517:prevention & control*; D002648:Child; D017281:Cost of Illness; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009330:Nebulizers and Vaporizers; D010346:Patient Care Management / Q000592:standards*; D010349:Patient Compliance; D010353:Patient Education as Topic; D010372:Pediatrics / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents