Reasons for pediatrician nonadherence to asthma guidelines
Reasons for pediatrician nonadherence to asthma guidelines
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DOI：
10.1001/archpedi.155.9.1057
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发表时间：
2001-09-01
影响因子：
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通讯作者：
Rubin, HR
中科院分区：
文献类型：
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作者：
Cabana, MD;Rand, CS;Rubin, HR
背景资料：1997年美国国家心脏、肺和血液研究所（NHLBI）哮喘指南包括关于如何提高哮喘护理质量的建议。目的：确定医生遵守NHLBI指南的障碍。设计：横断面调查。参与者：829名初级保健儿科医生的国家随机样本。主要结果测量：自我报告遵守NHLBI指南的4个组成部分（类固醇处方，指导峰值流量计使用，筛查和咨询哮喘患者吸烟，筛查和咨询父母吸烟）。我们还收集了关于医生人口统计学、实践特征和可能的依从性障碍的信息。我们定义为遵循一个指南组件超过90%的time.Results：响应率为55%（456/829）。大多数受访儿科医生都知道该指南（88%），并报告有机会获得该指南的副本（81%）。自我报告的遵守率为39%至53%之间的指南组成部分。在控制了人口统计学和其他障碍后，我们发现不依从与每个指南组成部分的特定障碍相关：对于皮质类固醇处方，缺乏一致性，（比值比[OR]，6.8; 95%置信区间[CI]，3.2-14.4）;对于峰值流量计使用，缺乏自我效能（OR，3.4; 95% CI，1.9-6.1）和缺乏结局预期（OR，4.7; 95%CI，2.5-8.9）;对于筛查和咨询患者和父母吸烟，缺乏自我效能结论：尽管该样本中的儿科医生了解NHLBI指南，但各种障碍阻碍了其成功使用。为了提高NHLBI指南的遵守，需要实施针对特定指南组成部分的障碍特征的定制干预措施。
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.