Barriers pediatricians face when using asthma practice guidelines
Barriers pediatricians face when using asthma practice guidelines
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DOI：
10.1001/archpedi.154.7.685
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发表时间：
2000-07-01
影响因子：
--
通讯作者：
Rand, CS
中科院分区：
文献类型：
--
作者：
Cabana, MD;Ebel, BE;Rand, CS
目的：描述成功使用1997年国家心肺血液研究所（NHLBI）哮喘指南的障碍。方法：我们进行了3个焦点小组，以了解使用NHLBI指南中4项建议的障碍（吸入性皮质类固醇的处方、每日峰值流量计使用的推荐、戒烟筛查和咨询以及过敏原暴露咨询）。21名儿科医生和1名执业护士，每人平均随访47名哮喘患者。六名参与者（27%）在医学院担任教职或兼职。十九（90%）的21名儿科医生董事会certified.Results：我们确定了171条意见的障碍，坚持。推荐信类型和毕业年限与哪种障碍突出有关。对于皮质类固醇处方，资深医生提到缺乏一致性，而年轻医生描述缺乏剂量或认识禁忌症的信心。对于峰值流量计的使用，资深医师强调缺乏培训。只有资深医生认为以前的实践惯性是一个障碍。所有组提到的时间limits.Conclusions：努力提高遵守哮喘指南应考虑的障碍，儿科医生面临的范围，如缺乏认识，熟悉，或协议，和外部障碍，由于环境，指导方针，或患者因素。此外，本研究记录了以前未考虑的障碍，如缺乏自我效能，缺乏预期结果，以及以前实践的惯性，这些障碍阻碍了依从性，建议的原因类型和医生人口统计学与哪些障碍突出有关，应针对这些因素进行干预，以提高NHLBI指南的依从性。
Objective: To describe barriers to the successful use of the 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines.Methods; We conducted 3 focus groups to understand barriers to the use of 4 recommendations within the NHLBI guidelines (prescription of inhaled corticosteroids, recommendation of daily peak flowmeter use, smoking cessation screening and counseling, and allergen exposure counseling).Participants: Twenty-one pediatricians and 1 nurse practitioner, who each followed an average of 47 patients with asthma, participated. Six participants (27%) had a faculty or adjunct appointment at a medical school. Nineteen (90%) of the 21 pediatricians were board certified.Results: We identified 171 comments about barriers to adherence. Type of recommendation and physician year of graduation from medical school were related to which barrier was prominent. For corticosteroid prescription, senior physicians mentioned lack of agreement, whereas younger physicians described lack of confidence in dosing or recognizing contraindications. For peak flowmeter use, senior physicians emphasized lack of training. Only senior physicians described the inertia of previous practice as a barrier. All groups mentioned time limitations.Conclusions: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors. In addition, this study documents barriers not previously considered, such as lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice, that prevent adherence, Be cause type of recommendation and physician demographics are related to which barriers are prominent, interventions to improve NHLBI guideline adherence should be tailored to these factors.