title: Demonstrating and assessing metered-dose inhaler-spacer technique: pediatric care providers' self-reported practices and perceived barriers.
abstract: The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler-spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient's asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed.
authors: 1Children's Hospital at Montefiore, Bronx, NY, USA.
authors: Marina
authors: M
authors: Reznik
authors: Yudilyn
authors: Y
authors: Jaramillo
authors: Judith
authors: J
authors: Wylie-Rosett
mesh_terms: D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D009519:New York City; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D018927:Anti-Asthmatic Agents
keywords: MDI-spacer technique; asthma; barriers; pediatric care provider