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. 2018 May-Jun;6(3):886-894.e4.
doi: 10.1016/j.jaip.2018.01.018. Epub 2018 Feb 3.

Clinician Agreement, Self-Efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma

Michelle M Cloutier  1 , Paivi M Salo  2 , Lara J Akinbami  3 , Richard D Cohn  4 , Jesse C Wilkerson  4 , Gregory B Diette  5 , Sonja Williams  6 , Kurtis S Elward  7 , Jacek M Mazurek  8 , Jovonni R Spinner  9 , Tracey A Mitchell  10 , Darryl C Zeldin  2
Affiliations

Clinician Agreement, Self-Efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma

Michelle M Cloutier et al. J Allergy Clin Immunol Pract. 2018 May-Jun.

Abstract

Background: The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines.

Objective: To assess clinician-reported adherence with specific guideline recommendations, as well as agreement with and self-efficacy to implement guidelines.

Methods: We analyzed 2012 National Asthma Survey of Physicians data for 1412 primary care clinicians and 233 asthma specialists about 4 cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; 2 overall indices of agreement and self-efficacy were compiled. Adherence was compared between primary care clinicians and asthma specialists. Logistic regression models assessed the association of agreement and self-efficacy indices with adherence.

Results: Asthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than did primary care clinicians. Adherence was low among both groups for specific core recommendations, including written asthma action plan (30.6% and 16.4%, respectively; P < .001); home peak flow monitoring, (12.8% and 11.2%; P = .34); spirometry testing (44.7% and 10.8%; P < .001); and repeated assessment of inhaler technique (39.7% and 16.8%; P < .001). Among primary care clinicians, greater self-efficacy was associated with greater adherence. For specialists, self-efficacy was associated only with increased odds of spirometry testing. Guideline agreement was generally not associated with adherence.

Conclusions: Agreement with and adherence to asthma guidelines was higher for specialists than for primary care clinicians, but was low in both groups for several key recommendations. Self-efficacy was a good predictor of guideline adherence among primary care clinicians but not among specialists.

Keywords: Adherence; Agreement; Asthma guidelines; Confidence; National Asthma Survey; Primary care; Specialist.

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Conflict of interest statement

Disclosure: No conflicts of interest for any author.

Figures

Figure 1
Figure 1
Clinician reported frequency of patient misunderstanding and concerns about asthma medications Note: Results for all four medication questions differ statistically significantly between primary care clinicians and allergy specialists (chi square P value<.05). * Relative standard error > 30%. Source: NCHS, National Ambulatory Medical Care Survey, 2012.
Figure 2
Figure 2
Clinician-Reported Use of Asthma Medications, by Specialty † P Value <.05 for pairwise difference between asthma specialists and primary care. * Relative standard error > 30%. Source: NCHS, National Ambulatory Medical Care Survey, 2012.
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