Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians

Michelle M. Cloutier, Howard Tennen, Dorothy B. Wakefield, Kevin Brazil, Charles B. Hall

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing). Methods: A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy. Results: At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04-1.72; P =.04) but not treatment plan development (RR, 0.63; 95% CI, 0.29-1.35; P =.23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92-3.35; P =.09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P =.01) and more clinicians were in an action stage of change (P =.001) but these changes were not associated with changes in primary or secondary outcomes. Conclusions: Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.

Original languageEnglish (US)
Pages (from-to)312-318
Number of pages7
JournalAcademic Pediatrics
Volume12
Issue number4
DOIs
StatePublished - Jul 2012

Fingerprint

Self Efficacy
Primary Health Care
Asthma
Guidelines
Confidence Intervals
Respiration
Incentive Reimbursement
Therapeutics
Telecommunications
Anti-Inflammatory Agents
Randomized Controlled Trials
Pediatrics

Keywords

  • academic detailing
  • contingency management
  • pay for performance
  • social learning theory
  • stage of change

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians. / Cloutier, Michelle M.; Tennen, Howard; Wakefield, Dorothy B.; Brazil, Kevin; Hall, Charles B.

In: Academic Pediatrics, Vol. 12, No. 4, 07.2012, p. 312-318.

Research output: Contribution to journalArticle

Cloutier, Michelle M. ; Tennen, Howard ; Wakefield, Dorothy B. ; Brazil, Kevin ; Hall, Charles B. / Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians. In: Academic Pediatrics. 2012 ; Vol. 12, No. 4. pp. 312-318.
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