TY - JOUR
T1 - Use of National Asthma Guidelines by Allergists and Pulmonologists
T2 - A National Survey
AU - Cloutier, Michelle M.
AU - Akinbami, Lara J.
AU - Salo, Paivi M.
AU - Schatz, Michael
AU - Simoneau, Tregony
AU - Wilkerson, Jesse C.
AU - Diette, Gregory
AU - Elward, Kurtis S.
AU - Fuhlbrigge, Anne
AU - Mazurek, Jacek M.
AU - Feinstein, Lydia
AU - Williams, Sonja
AU - Zeldin, Darryl C.
N1 - Funding Information:
This work was supported, in part, by the Intramural Research Program of the National Institutes of Health , National Institute of Environmental Health Sciences (Z01 ES025041), and through a contract to Social & Scientific Systems funded by the National Institute of Environmental Health Sciences ( HHSN273201600002I ).
Funding Information:
This work was supported, in part, by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (Z01 ES025041), and through a contract to Social & Scientific Systems funded by the National Institute of Environmental Health Sciences (HHSN273201600002I).Conflicts of interest: M. Schatz receives research funding paid to his institution from Merck and ALK. This work is not related to the current manuscript. A. Fuhlbrigge is an unpaid consultant to AstraZeneca for the development of asthma and chronic obstructive pulmonary disease?related outcome measures and a consultant to Novartis for analyses related to asthma control. Neither of these projects is directly related to the current manuscript. The rest of the authors declare that they have no relevant conflicts of interest.
Publisher Copyright:
© 2020
PY - 2020/10
Y1 - 2020/10
N2 - Background: Little is known about specialist-specific variations in guideline agreement and adoption. Objective: To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Methods: Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and “almost always” adhering to recommendations (ie, ≥75% of the time). Results: Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups “almost always” assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P =.06), asked about nighttime awakening (91.9% vs 76.5%, P =.03) and emergency department visits (92.2% vs 76.5%, P =.03), assessed home triggers (70.5% vs 52.6%, P =.06), and performed allergy testing (61.8% vs 21.3%, P <.001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Conclusions: Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
AB - Background: Little is known about specialist-specific variations in guideline agreement and adoption. Objective: To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Methods: Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and “almost always” adhering to recommendations (ie, ≥75% of the time). Results: Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups “almost always” assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P =.06), asked about nighttime awakening (91.9% vs 76.5%, P =.03) and emergency department visits (92.2% vs 76.5%, P =.03), assessed home triggers (70.5% vs 52.6%, P =.06), and performed allergy testing (61.8% vs 21.3%, P <.001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Conclusions: Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
KW - Agreement
KW - Asthma treatment plan
KW - Inhaler technique
KW - NAEPP
KW - Self-efficacy
KW - Spirometry
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U2 - 10.1016/j.jaip.2020.04.026
DO - 10.1016/j.jaip.2020.04.026
M3 - Article
C2 - 32344187
AN - SCOPUS:85084765732
VL - 8
SP - 3011-3020.e2
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 9
ER -