Specialty differences in prescribing inhaled corticosteroids for children
Specialty differences in prescribing inhaled corticosteroids for children
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DOI：
10.1177/0009922807301436
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发表时间：
2007-10-01
影响因子：
1.6
通讯作者：
Yawn, Barbara
中科院分区：
文献类型：
--
作者：
Cabana, Michael D.;Abu-Sa, Heba;Yawn, Barbara
与国家实践指南相比，持续性哮喘儿童每日吸入糖皮质激素的处方很少。作者对儿科医生和家庭医生进行了一项全国性的横断面调查，以确定与医生不遵守国家心脏，肺和血液研究所吸入性皮质类固醇处方指南相关的专业差异和因素。依从性定义为遵循>90%病例的建议。有效率为49%（343/694）。儿科医生和家庭医生报告了相似的依从率（54%对51%）。儿科医生和家庭医生报告了不同的障碍。虽然两组都表明父母的犹豫和不依从是常见的障碍，但家庭医生最常见的障碍是家庭哮喘药物的感知成本。儿科医生更可能指出，缺乏时间（21%对10%）是处方吸入性皮质类固醇的障碍。在多变量logistic分析中，缺乏家庭/实践障碍（优势比，0.27; 95%置信区间，0.27）。13，0.55）和医生同意国家心脏，肺和血液研究所的建议（比值比，4.21; 95%置信区间，1.43，12.3）与自我报告的依从性相关。改善吸入性皮质类固醇处方的干预措施应包括解决儿科医生和家庭医生特有问题的策略。
Prescription of daily inhaled corticosteroids for children with persistent asthma is infrequent compared with national practice guidelines. The authors conducted a national, cross-sectional survey of pediatricians and family physicians to identify specialty differences and factors associated with physician nonadherence to National Heart, Lung, and Blood Institute guidelines for prescribing inhaled corticosteroids. Adherence was defined as following the recommendation for >90% of cases. Response rate was 49% (343/694). Pediatrician and family physicians reported similar rates of adherence (54% vs; 51 %). Pediatricians and family physicians reported different barriers. Although both groups indicated that parent hesitancy and nonadherence were common barriers, the most common barrier for family physicians was a perceived cost of the asthma medications for families. Pediatricians were more likely to indicate that lack of time (21 % vs 10%) was a barrier to prescribing inhaled corticosteroids. In multivariate logistic analysis, the lack of a family/practice barrier (odds ratio, 0.27; 95% confidence interval, 0. 13, 0.55) and physician agreement with the National Heart, Lung, and Blood Institute recommendation (odds ratio, 4.21; 95% confidence interval, 1.43, 12.3) was associated with self-reported adherence. Interventions to improve prescribing of inhaled corticosteroids should include strategies to address issues specific to pediatricians and family physicians.