Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians.
OBJECTIVE
The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).


METHODS
A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy.


RESULTS
At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04-1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29-1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92-3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes.


CONCLUSIONS
Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.
Department of Pediatrics, University of Connecticut Health Center, Farmington, CT, USA. mclouti@ccmckids.org
Michelle M
MM
Cloutier
Howard
H
Tennen
Dorothy B
DB
Wakefield
Kevin
K
Brazil
Charles B
CB
Hall
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology; D010372:Pediatrics / Q000193:education; D010823:Physician Assistants / Q000193:education / Q000523:psychology; D058007:Physicians, Primary Care / Q000193:education* / Q000523:psychology; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D020377:Self Efficacy