Clinician Agreement, Self-efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma

Publication date: Available online 3 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Michelle M. Cloutier, Paivi M. Salo, Lara J. Akinbami, Richard D. Cohn, Jesse C. Wilkerson, Gregory B. Diette, Sonja Williams, Kurtis S. Elward, Jacek M. Mazurek, Jovonni R. Spinner, Tracey A. Mitchell, Darryl C. Zeldin
BackgroundThe 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines.ObjectiveTo assess clinician-reported adherence with specific guideline recommendations, as well as agreement with and self-efficacy to implement guidelinesMethodsWe analyzed 2012 National Asthma Survey of Physicians data for 1412 primary care clinicians and 233 asthma specialists about four cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; two overall indices of agreement and self-efficacy were compiled. Adherence was compared between primary care clinicians and asthma specialists. Logistic regression models assessed the association of agreement and self-efficacy indices with adherence.ResultsAsthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than primary care clinicians. Adherence was low among both groups for specific core recommendations, including written asthma action plan (30.6% and 16.4%, respectively P<.001); home peak flow monitoring, (12.8% and 11.2%, P=.34); spirometry testing, (44.7% and 10.8%, P<.001); and repeated assessment of inhaler technique, (39.7% and 16.8%, P<.001). Among primary care clinicians, greater self-efficacy was associated with greater adherence. For specialists, self-efficacy was associated only with increased odds of spirometry testing. Guideline agreement was generally not associated with adherence.ConclusionsAgreement with and adherence to asthma guidelines was higher for specialists than primary care clinicians, but was low in both groups for several key recommendations. Self-efficacy was a good predictor of guideline adherence among primary care clinicians but not among specialists.