title: Interventions to modify health care provider adherence to asthma guidelines: a systematic review.
abstract: OBJECTIVE
  Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes.
  
  
  METHODS
  Data sources included Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, and Research and Development Resource Base in Continuing Medical Education up to July 2012. Paired investigators independently assessed study eligibility. Investigators abstracted data sequentially and independently graded the evidence.
  
  
  RESULTS
  Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-for-performance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance.
  
  
  CONCLUSIONS
  Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes.
authors: David Geffen School of Medicine and Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
authors: Sande O
authors: SO
authors: Okelo
authors: Arlene M
authors: AM
authors: Butz
authors: Ritu
authors: R
authors: Sharma
authors: Gregory B
authors: GB
authors: Diette
authors: Samantha I
authors: SI
authors: Pitts
authors: Tracy M
authors: TM
authors: King
authors: Shauna T
authors: ST
authors: Linn
authors: Manisha
authors: M
authors: Reuben
authors: Yohalakshmi
authors: Y
authors: Chelladurai
authors: Karen A
authors: KA
authors: Robinson
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004502:Education, Medical, Continuing; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D008485:Medical Audit; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010593:Pharmaceutical Services / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D016032:Randomized Controlled Trials as Topic; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma; guidelines; systematic review
references: Arch Pediatr Adolesc Med. 2006 May;160(5):535-41
references: 16651498
references: Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3:29-34
references: 17935573
references: Prim Care Respir J. 2008 Jun;17(2):90-6
references: 18274692
references: Dis Manag. 2004 Summer;7(2):102-11
references: 15228795
references: Health Serv Res. 2005 Dec;40(6 Pt 1):1737-57
references: 16336546
references: Ann Allergy Asthma Immunol. 2004 Sep;93(3):237-42
references: 15478382
references: JAMA. 2002 Oct 2;288(13):1594-602
references: 12350190
references: Med Care. 2008 Dec;46(12):1257-66
references: 19300316
references: BMJ. 1999 May 8;318(7193):1251-5
references: 10231256
references: J Urban Health. 2011 Feb;88 Suppl 1:38-48
references: 21337050
references: Fam Med. 2010 May;42(5):334-7
references: 20455109
references: Adv Data. 2006 Dec 12;(381):1-24
references: 17180851
references: J Clin Epidemiol. 2013 Feb;66(2):151-7
references: 22542023
references: Pediatrics. 2010 Apr;125(4):e770-7
references: 20231191
references: Ambul Pediatr. 2005 Mar-Apr;5(2):75-82
references: 15780018
references: J Asthma Allergy. 2008 Aug 31;1:1-10
references: 21436980
references: Ann Allergy Asthma Immunol. 2008 Sep;101(3):264-70
references: 18814449
references: BMJ. 1995 Dec 2;311(7018):1473-8
references: 8520339
references: J Asthma. 2001 Oct;38(7):565-73
references: 11714079
references: Lancet. 2008 Sep 20;372(9643):1065-72
references: 18805335
references: Pediatrics. 2002 Jan;109(1):E1
references: 11773569
references: J Pediatr. 1999 Sep;135(3):332-8
references: 10484799
references: Arch Pediatr Adolesc Med. 2011 May;165(5):412-8
references: 21536955
references: J Sch Health. 2006 Aug;76(6):303-6
references: 16918860
references: Pediatrics. 2009 Aug;124(2):729-42
references: 19651589
references: Eval Health Prof. 2011 Sep;34(3):309-35
references: 21177641
references: MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):547-52
references: 21544044
references: Br J Gen Pract. 2003 Apr;53(489):284-91
references: 12879828
references: Ann Pharmacother. 2003 Jul-Aug;37(7-8):956-61
references: 12841800
references: Pediatrics. 1998 May;101(5):831-6
references: 9565410
references: Pediatrics. 2009 Mar;123 Suppl 3:S131-45
references: 19221156
references: Can Respir J. 2006 May-Jun;13(4):193-7
references: 16779463
references: J Eval Clin Pract. 2008 Apr;14(2):185-90
references: 18093108
references: J Pediatr. 2005 May;146(5):591-7
references: 15870660
references: Med Inform Internet Med. 2001 Jul-Sep;26(3):191-201
references: 11706929
references: Clin Pediatr (Phila). 2003 Mar;42(2):121-5
references: 12659384
references: J Pediatr Health Care. 2011 Jul-Aug;25(4):235-49
references: 21700138
references: Dis Manag. 2008 Jun;11(3):145-52
references: 18564026
references: Arch Dis Child. 2010 Apr;95(4):302-4
references: 19395402
references: Pediatrics. 2000 Jan;105(1 Pt 3):272-6
references: 10617735
references: Arch Pediatr Adolesc Med. 2005 May;159(5):464-9
references: 15867121
references: Mil Med. 2005 Mar;170(3):243-6
references: 15828703
references: J Asthma. 2000 May;37(3):247-57
references: 10831149
references: Int J Tuberc Lung Dis. 2004 Jul;8(7):873-81
references: 15260280
references: Arch Pediatr Adolesc Med. 2005 May;159(5):422-7
references: 15867114
references: Clin Pediatr (Phila). 2005 May;44(4):319-25
references: 15864364
references: Ann Pharmacother. 2004 Nov;38(11):1954-60
references: 15479780
references: J Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94-138
references: 17983880
references: Pediatrics. 2006 Jun;117(6):2149-57
references: 16740859
references: J Am Pharm Assoc (Wash). 2001 Jul-Aug;41(4):551-9
references: 11486981
references: Respir Care. 2006 Jan;51(1):49-55
references: 16381618
references: Thorax. 2007 Jun;62(6):496-502
references: 17251316
references: Arch Pediatr Adolesc Med. 2006 Oct;160(10):1018-25
references: 17018460
references: Int J Qual Health Care. 2011 Oct;23(5):545-53
references: 21733979
references: Arch Pediatr Adolesc Med. 2002 Feb;156(2):141-6
references: 11814375
references: J Asthma. 2005 Jul-Aug;42(6):499-505
references: 16293546
references: J Asthma. 2010 Aug;47(6):680-6
references: 20632781
references: J Clin Epidemiol. 1999 Aug;52(8):801-12
references: 10465325
references: Int J Med Inform. 2007 Dec;76 Suppl 3:S403-16
references: 17569575
references: BMJ. 2003 Sep 20;327(7416):659
references: 14500440
references: Acta Paediatr. 2005 Feb;94(2):226-33
references: 15981759
references: Pediatrics. 2006 Jun;117(6):e1095-103
references: 16740812
references: J Clin Epidemiol. 2000 Jul;53(7):762-72
references: 10941955
references: Pediatrics. 2000 Apr;105(4 Pt 1):767-73
references: 10742318
references: Am J Respir Crit Care Med. 1999 Oct;160(4):1254-62
references: 10508816
references: Eur J Clin Pharmacol. 2002 May;58(2):127-32
references: 12012145
references: Pediatrics. 2011 Jul;128(1):20-8
references: 21669890
references: Chest. 2004 Aug;126(2):369-74
references: 15302719
references: Qual Health Care. 1999 Jun;8(2):92-8
references: 10557684
references: BMJ. 2002 Oct 26;325(7370):941
references: 12399345
references: Arch Pediatr Adolesc Med. 2004 Sep;158(9):875-83
references: 15351753
references: Pediatrics. 2007 Oct;120(4):e902-11
references: 17908746
references: J Allergy Clin Immunol. 2009 Sep;124(3):436-44, 444e1-8
references: 19632710
references: Med J Aust. 2011 Oct 3;195(7):405-9
references: 21978349
references: J Asthma. 2009 May;46(4):392-8
references: 19484676
references: BMC Health Serv Res. 2006 Nov 02;6:145
references: 17081285
references: Am J Manag Care. 2001 Sep;7(9):897-906
references: 11570023
references: Can Respir J. 2001 Mar-Apr;8 Suppl A:41A-5A
references: 11360047
references: J Am Board Fam Med. 2011 May-Jun;24(3):240-8
references: 21551395
references: J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S49-64
references: 22386509
references: Acad Pediatr. 2012 Jul-Aug;12(4):312-8
references: 22634077
references: J Contin Educ Health Prof. 2010 Spring;30(2):106-13
references: 20564712
references: Fam Pract. 2010 Jun;27(3):246-54
references: 20332178
references: J Am Pharm Assoc (Wash). 2002 Sep-Oct;42(5):743-52
references: 12269709
references: Am J Manag Care. 2009 Jun;15(6):345-51
references: 19514800
references: Fam Med. 2002 Jul-Aug;34(7):514-7
references: 12144005
references: BMJ. 1995 Apr 1;310(6983):838-42
references: 7711623
references: Trop Med Int Health. 2010 Mar;15(3):277-86
references: 20070633
references: Stud Health Technol Inform. 2000;76:107-21
references: 10947496
references: Arch Pediatr Adolesc Med. 2002 Oct;156(10):1045-51
references: 12361453
references: Health Bull (Edinb). 1997 May;55(3):150-5
references: 9364102
references: J Clin Epidemiol. 2010 May;63(5):513-23
references: 19595577