Environmental management of asthma in clinical practice: Results from the 2012 National Ambulatory Medical Care Survey

Abstract

Background: The National Asthma Education and Prevention Program guidelines emphasize environmental control as an integral part of asthma management; however, limited national-level data exist on how clinicians implement environmental control recommendations.

Objective: We analyzed data on clinicians' self-reported use of recommended environmental control practices in a nationally representative sample (n = 1645) of primary care physicians, asthma specialists, and advanced practice providers from the National Asthma Survey of Physicians, a supplemental questionnaire to the 2012 National Ambulatory Medical Care Survey.

Methods: We examined clinician and practice characteristics as well as clinicians' decisions and strategies regarding environmental trigger assessment and environmental control across provider groups. Regression modeling was used to identify clinician and practice characteristics associated with implementation of guideline recommendations.

Results: A higher percentage of specialists assessed asthma triggers at home, school, and/or work than primary care or advanced practice providers (almost always: 53.6% vs 29.4% and 23.7%, respectively, P < .001). Almost all clinicians (>93%) recommended avoidance of secondhand tobacco smoke, whereas recommendations regarding cooking appliances (eg, proper ventilation) were infrequent. Although assessment and recommendation practices differed between clinician groups, modeling results showed that clinicians who reported almost always assessing asthma control were 5- to 6-fold more likely to assess environmental asthma triggers. Use of asthma action plans was also strongly associated with implementation of environmental control recommendations.

Conclusions: Environmental assessment and recommendations to patients varied among asthma care providers. High adherence to other key guideline components, such as assessing asthma control, was associated with environmental assessment and recommendation practices on environmental control.

Keywords: Asthma; asthma guidelines; environmental control; guideline implementation; national survey.

Fig 1

Weighted percentage of clinicians almost always assessing environmental triggers at home and school/work during asthma visits. Chi-square test for difference between clinician groups (primary care providers, asthma specialists, CHC advanced practice providers); P < .001.

Fig 2

Weighted percentage of clinicians recommending environmental control practices by clinician group. Chi-square test for difference between groups (AS, asthma specialist; CHC, CHC advanced practice provider; PC, primary care provider); ∗P < .05, ∗∗P < .001.

Fig 3

Factors associated with guideline implementation for environmental trigger assessment at home and school/work (assessment conducted almost always during asthma visits). Solid red or blue indicates direction of associations (red, positive; blue, negative; P < .05) when each of clinician/practice characteristic categories was compared to reference category adjusting for other independent variables in final group-specific models. Dashed areas indicate clinician/practice characteristics included in initial full models based on bivariate analysis results.

Fig 4

Factors associated with guideline implementation for environmental control recommendations by clinician group. Solid red or blue indicates direction of associations (red, positive; blue, negative; P < .05) when each of clinician/practice characteristic categories was compared to reference category adjusting for other independent variables in final group-specific models. Dashed areas indicate clinician/practice characteristics included in initial full models based on bivariate analysis results.