title: Initiating inhaled steroid treatment for children with asthma in the emergency room: current reported prescribing rates and frequently cited barriers.
abstract: OBJECTIVE
  The objective of this study was to determine how frequently emergency department (ED) physicians prescribe inhaled corticosteroids (ICSs) and describe commonly cited barriers.
  
  
  METHODS
  We surveyed members of the American Academy of Pediatrics Section on Emergency Medicine between May and August 2011. Demographic data were collected. Using the knowledge-attitude-behavior model for barriers to physician guideline adherence, we asked 20 Likert scale questions regarding barriers to ICS prescribing. Our primary outcome was reported frequency of ICS prescribing. We defined frequent prescribers as those who prescribe ICS more than 25% of the time. Logistic regression models were built for each barrier category and identified barriers that predict infrequent prescribing.
  
  
  RESULTS
  Two hundred seven (19.5%) of the 1062 surveyed responded; 75.8% report prescribing ICS 25% of the time or less. For knowledge, those who agreed that the National Heart, Lung, and Blood Institute guidelines are not clear regarding the ED physician's role were less likely to be frequent prescribers compared with those who disagreed (adjusted odds ratio [OR], 0.31; 95% confidence interval [CI], 0.11-0.90). For attitude, those who agreed it is not the role of the ED physician to prescribe long-term medications were less likely to be frequent prescribers (adjusted OR, 0.12; 95% CI, 0.04-0.37). For behavior, those who agreed they do not routinely start long-term medications because they cannot see patients in follow-up were less likely to be frequent prescribers (adjusted OR, 0.21; 95% CI, 0.07-0.58).
  
  
  CONCLUSIONS
  Emergency department physicians report low rates of ICS prescribing. Commonly cited barriers include unclear guidelines, believing that long-term medication prescribing is not within their role, and inability to see patients in follow-up. Addressing guideline discrepancies may improve preventive care delivery in the ED.
authors: From the Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors: Annie Lintzenich
authors: AL
authors: Andrews
authors: Ronald J
authors: RJ
authors: Teufel
authors: William T
authors: WT
authors: Basco
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D054555:National Heart, Lung, and Blood Institute (U.S.) / Q000592:standards; D010372:Pediatrics; D010819:Physician's Role; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents