Adherence to pediatric asthma guidelines in the emergency department: a survey of knowledge, attitudes and behaviour among health care professionals.
BACKGROUND
Despite strong evidence for using clinical care pathways to manage acute pediatric asthma, adherence remains suboptimal.


OBJECTIVE
To elicit information from health care professionals regarding their knowledge, attitudes and use of a care pathway for acute childhood asthma.


METHODS
A cross-sectional, self-administered survey of physicians, nurses and respiratory therapists who worked in the emergency department at the Montreal Children's Hospital (Montreal, Quebec) from August to December 2007 was conducted. The survey assessed knowledge, attitude toward and agreement with the care pathway, as well as its use four years after its implementation.


RESULTS
Of the 128 health care professionals surveyed, 72 (56%) responded. Of these, 99% reported being familiar with the pathway, more than 90% agreed with its use for mild and moderate asthma, while 79% agreed with its use for severe asthma. For 99% of health care professionals, the advantages of using the pathway outweighed the disadvantages; however, 64% admitted to making variations to the pathway. Although 92% of respondents reported that they were quite comfortable with using the asthma severity Pediatric Respiratory Assessment Measure, only 53% and 36% correctly identified the severity score cut-offs for moderate and severe asthma, respectively. Seventeen per cent of respondents underestimated the delay of onset of action of oral corticosteroids, while 36% of physicians incorrectly believed that a higher than necessary dose was recommended for ipratropium bromide.


CONCLUSIONS
Results of the survey confirmed that the health care professionals queried had a positive attitude toward the pediatric asthma care pathway. Knowledge gaps and the balance between standardization versus individualization of care may be key elements to explain suboptimal adherence to the pathway.
Bhogal
Sanjit
S
Department of Epidemiology, Biostatisticss and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec.
Bourbeau
Jean
J
McGillivray
David
D
Benedetti
Andrea
A
Bartlett
Susan
S
Ducharme
Francine
F
D000465:Algorithms; D001249:Asthma / Q000628:therapy*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D011795:Surveys and Questionnaires
Acad Emerg Med. 2001 Dec;8(12):1147-52
11733292
CMAJ. 1996 Jul 1;155(1):25-37
8673983
Cochrane Database Syst Rev. 2000;(4):CD000060
11034671
J Pediatr. 2008 Apr;152(4):476-80, 480.e1
18346499
Med J Aust. 2002 Nov 4;177(9):502-6
12405894
J Qual Clin Pract. 2001 Sep;21(3):50-5
11892822
JAMA. 1999 Oct 20;282(15):1458-65
10535437
Pediatr Pulmonol. 2001 Sep;32(3):211-6
11536450
Arch Dis Child. 2007 Jan;92(1):60-6
16905562
Am J Emerg Med. 2000 Jul;18(4):367-71
10919520
CMAJ. 2000 Oct 3;163(7):837-41
11033714
Eur Respir J. 1992 May;5(5):601-41
1612163
BMJ. 1999 Feb 20;318(7182):527-30
10024268
BMJ. 2001 Nov 10;323(7321):1100-2
11701576
BMC Health Serv Res. 2003 Mar 24;3(1):8
12659640
Arch Intern Med. 2001 Sep 10;161(16):2037-42
11525707
BMJ. 2003 Mar 22;326(7390):649-52
12649244
Arch Pediatr Adolesc Med. 2000 Jul;154(7):685-93
10891020
Qual Saf Health Care. 2005 Aug;14(4):290-4
16076795
Arch Pediatr Adolesc Med. 2001 Sep;155(9):1057-62
11529809
Eur J Emerg Med. 2007 Jun;14(3):142-6
17473607
Cochrane Database Syst Rev. 2001;(1):CD002178
11279756