Asthma treatment decisions by pediatric residents do not consistently conform to guidelines or improve with level of training

Sande O. Okelo, George K. Siberry, Barry Solomon, Andrew L. Bilderback, Michiyo Yamazaki, Theresa Hetzler, Cynthia L. Ferrell, Nui Dhepyasuwan, Janet Rose Serwint

Research output: Contribution to journalArticle

Abstract

Objective To compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training. Methods We conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication. Results There were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training. Conclusions Pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.

Original languageEnglish (US)
Pages (from-to)287-293
Number of pages7
JournalAcademic Pediatrics
Volume14
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Asthma
Guidelines
Pediatrics
Therapeutics
Outpatients
Respiratory Sounds
Physical Examination
Hospitalization
Steroids
Education

Keywords

  • Asthma
  • CORNET
  • decision making
  • pediatric resident education
  • survey
  • treatment
  • vignettes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Asthma treatment decisions by pediatric residents do not consistently conform to guidelines or improve with level of training. / Okelo, Sande O.; Siberry, George K.; Solomon, Barry; Bilderback, Andrew L.; Yamazaki, Michiyo; Hetzler, Theresa; Ferrell, Cynthia L.; Dhepyasuwan, Nui; Serwint, Janet Rose.

In: Academic Pediatrics, Vol. 14, No. 3, 2014, p. 287-293.

Research output: Contribution to journalArticle

Okelo, Sande O. ; Siberry, George K. ; Solomon, Barry ; Bilderback, Andrew L. ; Yamazaki, Michiyo ; Hetzler, Theresa ; Ferrell, Cynthia L. ; Dhepyasuwan, Nui ; Serwint, Janet Rose. / Asthma treatment decisions by pediatric residents do not consistently conform to guidelines or improve with level of training. In: Academic Pediatrics. 2014 ; Vol. 14, No. 3. pp. 287-293.
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abstract = "Objective To compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training. Methods We conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication. Results There were 369 resident respondents (65{\%} response rate), 26{\%} postgraduate year (PGY) 1, 38{\%} PGY2, and 36{\%} PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97{\%} overall stepping up treatment for mild persistent asthma; and second, 52{\%} overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82{\%} of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75{\%} of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60{\%}) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27{\%}) or when wheezing was reported at physical examination (43{\%}). There were no statistically significant differences for any of the comparisons by year in training. Conclusions Pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.",
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AU - Yamazaki, Michiyo

AU - Hetzler, Theresa

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AB - Objective To compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training. Methods We conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication. Results There were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training. Conclusions Pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.

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