Self-reported physician practices for children with asthma: are national guidelines followed?
Self-reported physician practices for children with asthma: are national guidelines followed?
复制标题
自我报告的医生对哮喘儿童的治疗实践：是否遵循国家指南？
DOI：
10.1542/peds.106.s3.886
复制
发表时间：
2000
期刊：
影响因子：
8
通讯作者：
K. Weiss
中科院分区：
文献类型：
--
作者：
J. Finkelstein;P. Lozano;Reeva Shulruff;T. Inui;Stephen B. Soumerai;Mitzi Ng;K. Weiss
目的
确定管理式护理中初级保健医生自我报告的对国家儿童哮喘指南的依从性;并按医生专业和管理式护理实践类型分析这些实践的差异来源。
设计
一项对在3个地理位置不同的管理式医疗机构（MCO）执业的671名初级保健医生（儿科医生和家庭医生）的调查。感兴趣的领域包括哮喘诊断、药物治疗、患者教育和随访以及专科转诊指征。项目格式包括自我报告的通常做法和反应的情况下小插曲。
结果
共有429名（64%）医生返回调查，其中22人不符合纳入分析的标准。大多数受访者都听说过（91%）和阅读（72%）国家哮喘教育和预防计划（NAEPP）指南。对于诊断，75%的人报告常规使用办公室峰值流量测量，但只有21%的人常规使用肺功能测定。家庭医生比儿科医生更可能使用肺功能测定法进行诊断（比值比[OR] = 5.9），而不太可能推荐每日峰值流量测量（OR =.3）。提供书面护理计划的频率中位数仅为50%。虽然93%的人认为吸入性皮质类固醇非常安全或安全，但几乎一半的人对至少1种副作用有具体的担忧，最常见的是生长迟缓。初级保健医生转诊哮喘专家的标准与NAEPP小组的标准不同，他们选择在没有哮喘专家输入的情况下管理更严重的患者。家庭医生比儿科医生更有可能在一次住院、2至3次急诊、2次急性加重后或如果孩子<3岁且需要每日用药后转诊。对小插曲的反应显示，一般适当的初始使用抗抑郁剂，但不愿意增加剂量，以应对持续的症状，并不经常随访比NAEPP推荐的。
结论
大多数儿童医生报告说，他们已经阅读并采纳了NAEPP哮喘治疗指南的建议，包括一般适当的药物使用。改善的机会存在于特定领域，如使用书面护理计划，优化药物剂量，并提供常规随访。虽然医生表现出对国家指南的认识和与其内容一致的知识的证据，需要更多的工作，以促进在实践中使用自我管理工具。
OBJECTIVE
To determine self-reported adherence to national asthma guidelines for children by primary care physicians in managed care; and, to analyze sources of variation in these practices by physician specialty and managed care practice type.
DESIGN
A survey of 671 primary care physicians (pediatricians and family physicians) practicing in 3 geographically diverse managed care organizations (MCO). Domains of interest included asthma diagnosis, pharmacotherapy, patient education and follow-up, and indications for specialty referral. Item formats included self-reports of usual practice and responses to case vignettes.
RESULTS
A total of 429 (64%) physicians returned surveys, 22 of whom did not meet criteria for inclusion in the analysis. Most respondents had both heard of (91%) and read (72%) the National Asthma Education and Prevention Program (NAEPP) guidelines. For diagnosis, 75% reported routine use of office peak flow measurement, but only 21% used spirometry routinely. Family physicians were more likely than pediatricians to use spirometry in diagnosis (odds ratio [OR] = 5.9), and less likely to recommend daily peak flow measurement (OR =.3). The median reported frequency of providing written care plans was only 50%. Though inhaled corticosteroids were deemed very safe or safe by 93%, almost half had specific concerns regarding at least 1 side effect, most commonly growth delay. Primary care physicians' criteria for referral to an asthma specialist differed from those of the NAEPP panel in choosing to manage more severe patients without asthma specialist input. Family physicians were more likely than pediatricians to refer a child after a single hospitalization, 2 to 3 emergency department visits, after 2 exacerbations, or if the child was <3 years old and required daily medications. Responses to vignettes showed generally appropriate initial use of antiinflammatory agents, but reluctance to increase the dose in response to continued symptoms, and less frequent follow-up than recommended by the NAEPP.
CONCLUSION
Most physicians for children report having read and adopted NAEPP guideline recommendations for asthma treatment, including generally appropriate use of medications. Opportunities for improvement exist in specific areas such as the use of written care plans, optimizing antiinflammatory dosing, and providing routine follow-up. Although physicians show evidence of awareness of national guidelines and knowledge consistent with much of their content, additional work is required to promote the use of self-management tools in practice.
影响因子：
2.6
作者：
Adams, AS;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D