title: Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?
abstract: OBJECTIVE
  Amongst general practices in the NHS Borders region of Scotland, we aimed to determine compliance with the three key recommendations of the British Guideline for the Management of Asthma and to understand the nature of barriers and facilitators to their implementation.
  
  
  METHODS
  Using piloted audit tools, a researcher extracted data from computerised and/or paper patient medical records to assess compliance with recommendations for objective diagnosis and stepwise management. Provision of asthma action plans was assessed by patient survey. Clinicians' attitude to guidelines was assessed by postal survey.
  
  
  RESULTS
  Fifteen of the 24 practices in the NHS Borders region participated. Audited compliance with the three key recommendations varied markedly amongst and within practices. Whilst 367/547 (67%) of patients were treated appropriately with add-on therapy, only 58/254 (23%) of patients reported having been given an asthma action plan. Barriers to implementation identified by the clinicians' survey (response rate 64/84 - 76%) were theoretical (doubt about the evidence base and relevance to primary care, lack of knowledge and skills, misconceptions) as well as practical (lack of time and resources) and were exacerbated by poor teamwork. Facilitators were good teamwork and appropriate organisation of work within the practice.
  
  
  CONCLUSIONS
  Implementation of key recommendations was variable, particularly in the more complex intervention of issuing asthma action plans. An intervention to enhance compliance with these guideline recommendations will need to address both theoretical and practical barriers within the context of improved teamwork.
authors.affiliation: Department of Public Health, NHS Borders, Newstead, Melrose, TD6 9DB, Scotland, UK. Sharon.Wiener-Ogilvie@nes.scot.nhs.uk
authors.forename: Sharon
authors.initials: S
authors.lastname: Wiener-Ogilvie
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Guro
authors.initials: G
authors.lastname: Huby
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
authors.forename: John
authors.initials: J
authors.lastname: Gillies
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000628:therapy; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D009313:National Health Programs; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D012606:Scotland; D012648:Self Care; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones