Reasons for pediatrician nonadherence to asthma guidelines

Michael D. Cabana, Cynthia S. Rand, Oren J. Becher, Haya R. Rubin

Research output: Contribution to journalArticle

214 Citations (Scopus)

Abstract

Background: The 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines include recommendations on how to improve the quality of care for asthma. Objective: To identify barriers to physician adherence to the NHLBI guidelines. Design: Cross-sectional survey. Participants: A national random sample of 829 primary care pediatricians. Main Outcome Measures: Self-reported adherence to 4 components of the NHLBI guidelines (steroid prescription, instructing peak flow meter use, screening and counseling patients with asthma for smoking, and screening and counseling parents for smoking). We also collected information on physician demographics, practice characteristics, and possible barriers to adherence. We defined adherence as following a guideline component more than 90% of the time. Results: The response rate was 55% (456/829). Most of the responding pediatricians were aware of the guidelines (88%) and reported having access to a copy of the guidelines (81%). Self-reported rates of adherence were between 39% and 53% for the guideline components. After controlling for demographics and other barriers, we found that nonadherence was associated with specific barriers for each guideline component: for corticosteroid prescription, lack of agreement (odds ratio [OR], 6.8; 95% confidence interval [CI], 3.2-14.4); for peak flow meter use, lack of self-efficacy (OR, 3.4; 95% CI, 1.9-6.1) and lack of outcome expectancy (OR, 4.7; 95% CI, 2.5-8.9); and for screening and counseling of patients and parents for smoking, lack of self-efficacy (OR, 3.8; 95% CI, 1.7-6.2 and OR, 2.8; 95% CI, 1.3-5.9, respectively). Conclusions: Although pediatricians in this sample were aware of the NHLBI guidelines, a variety of barriers precluded their successful use. To improve NHLBI guideline adherence, tailored interventions that address the barriers characteristic of a given guideline component need to be implemented.

Original languageEnglish (US)
Pages (from-to)1057-1062
Number of pages6
JournalArchives of Pediatrics and Adolescent Medicine
Volume155
Issue number9
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

Fingerprint

Asthma
Guidelines
National Heart, Lung, and Blood Institute (U.S.)
Odds Ratio
Confidence Intervals
Counseling
Smoking
Self Efficacy
Prescriptions
Parents
Demography
Pediatricians
Physicians
Guideline Adherence
Quality of Health Care
Primary Health Care
Adrenal Cortex Hormones
Cross-Sectional Studies
Steroids
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Reasons for pediatrician nonadherence to asthma guidelines. / Cabana, Michael D.; Rand, Cynthia S.; Becher, Oren J.; Rubin, Haya R.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 155, No. 9, 01.01.2001, p. 1057-1062.

Research output: Contribution to journalArticle

Cabana, Michael D. ; Rand, Cynthia S. ; Becher, Oren J. ; Rubin, Haya R. / Reasons for pediatrician nonadherence to asthma guidelines. In: Archives of Pediatrics and Adolescent Medicine. 2001 ; Vol. 155, No. 9. pp. 1057-1062.
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