title: Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings: A Practice-Based Network Assessment.
abstract: OBJECTIVE
  To assess primary care adherence to 2007 US asthma guidelines.
  
  
  METHODS
  Patients with persistent asthma aged 5 to 65 years from 22 primary care participating practices provided the data for this analysis of baseline information from the pragmatic randomized clinical trial the Asthma Tools Study. Using a combination of abstracted medical record data and patient-reported demographic information, we assessed the medical record documentation for elements of the 2007 US asthma guidelines. Elements assessed included documentation of (1) assessment of control, (2) factors that affect control (medication adherence evaluation, inhaler technique education, and evaluation for triggers), (3) self-management support (action plan), and (4) asthma medications prescribed (short-acting β-agonists and daily maintenance therapy). The baseline data was collected from March 16, 2009, to May 1, 2014.
  
  
  RESULTS
  In 1176 patients (285 children, 211 tweens, and 680 adults) from 16 family medicine and 6 pediatric practices across the United States, documented guideline adherence was highest for prescription of medications (88.0% for short-acting β-agonists and 70.4% for maintenance medications) and lowest for an asthma action plan (3.1%). Documentation of control (15.0%) and factors that affect control (inhaler technique education, 7.6%; medication adherence assessment, 32.5%; and allergy evaluation, 32.5%) was not common and even less common for adults compared with children. A total of 22.2% of the enrolled patients had no asthma-related visit in the year before enrollment. Adherence to the nonmedication elements were higher in practices located in cities of more than 250,000 people and cities that used electronic medical records. Older patient age was negatively associated with guideline adherence.
  
  
  CONCLUSIONS
  Adherence to asthma guidelines is poor in primary care practices, leaving many opportunities for improvement.
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN. Electronic address: byawn47@gmail.com.
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.affiliation: Departments of Pediatrics, Epidemiology, and Biostatistics, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wollan
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Young J
authors.initials: YJ
authors.lastname: Juhn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D014481:United States; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents