Enhancing Pediatric Asthma Management

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DESCRIPTION (provided by the applicant): The National Heart, Lung, and Blood Institute (NHLBI) Guidelines for the Diagnosis and Management of Asthma recommend that practitioners prescribe daily anti-inflammatory medications for children with persistent asthma. The guidelines specifically describe corticosteroids as "the most potent and consistently effective long-term control medication for asthma". However, despite the publication of the NHLBI guidelines, there has been limited effect on physician prescription of daily-inhaled corticosteroids (DCS) for these patients. There are limited studies evaluating methods to improve physician adherence to the NHLBI asthma guidelines. Using a randomized controlled trial design, we will evaluate the effects of barrier assessment and a multi-faceted intervention to improve pediatrician prescription of DCS to children with persistent asthma. We have developed a theoretical framework that describes barriers that physicians must overcome before adhering to a guideline. In the first phase of the proposed project, at 22 primary care pediatric practices, using this framework, we will systematically assess barriers prescribing DCS to children with persistent asthma. In the second phase of the project, we will evaluate if a multi-faceted intervention featuring interactive physician seminars, based on the barrier assessment in the first phase can promote physician prescription of DCS to pediatric patients with persistent asthma. Over a three-year period, we will measure changes in pediatrician knowledge, attitudes and practice of DCS prescription using chart audits, parent telephone survey, and physician survey. It is expected that when compared to pediatricians in the control group, pediatricians who participate in the barrier assessment and multi-faceted educational seminars will have improved knowledge and attitudes towards the use of DCS, as well as increased prescription of DCS for their patients with persistent asthma.