Encouraging a systems approach for adherence to national asthma guidelines

Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review

OBJECTIVES

The aim of this systematic literature review is to study the enabling and hindering factors influencing adherence to asthma treatment among adolescents. Furthermore, it explores the role of caregivers and the healthcare provider in terms of supporting adolescents to manage and live with asthma.

DATA SOURCES

The literature review was conducted using the MeSH terms asthma, adherence, health literacy, behavior, adolescents, tools, healthcare provider, caregiver, peer influence, self-management, quality of life, morbidity and mortality in PubMed, PsycInfo, MEDLINE and CINAHL.

STUDY SELECTION

The literature search resulted in 652 articles of which 304 were screened based on title and abstracts. Ninety-one of the screened articles were then selected for full-text assessment resulting in 42 articles for in-depth analysis.

RESULTS

The literature review identified nine enabling and hindering factors relevant for adherence to asthma treatment among adolescents: behavior, belief, self-management, health literacy, role of health provider, assessment of adherence, role of caregiver, role of peers and the national asthma guidelines.

CONCLUSION

Working with this particular age group is complex and further research in understanding adolescent's behavior, motives, beliefs and perceptions towards adherence to asthma treatment is required to guide them towards better self-management and acceptance of their condition.

Provider Adherence to Evidence-Based Asthma Guidelines in a Community Health Center

Background: Improved outcomes for patients with asthma have been proven with the use of the Expert Panel Report 3 (EPR-3) evidence-based asthma guidelines. These clinical guidelines are tools developed for providers to direct appropriate high-quality patient care that leads to positive outcomes. However, research has shown health care providers do not routinely follow the evidence-based asthma guidelines adequately. Objective: To develop and implement an evidence-based asthma protocol in a community clinic and improve provider adherence and attitudes/beliefs to the EPR-3 guidelines resulting in improved asthma outcomes, asthma control, and self-management for patients with asthma. Methods: The study was conducted in 2 parts over a period of 3 months. First, all medical providers at a community clinic were invited to participate in the research study. The intervention included implementing the asthma protocol within the current electronic health record (EHR). A pre- and postintervention questionnaire measuring provider's adherence and attitudes to evidence-based practice was administered. In addition, pre- and postclinic aggregate data for International Classification of Diseases codes specific to asthma that correlate to 7 identified aims based on the EPR-3 guidelines were collected. Results: Results show statistical significance among the provider attitudes/beliefs with the intervention, the greatest effect being found for the medical doctors. Four of the 7 aims showed improvement. Conclusions: The findings of this application research quality improvement study indicate that providing necessary tools and resources needed to adhere to evidence-based asthma guidelines can positively affect providers' adherence and attitudes/beliefs toward evidence-based guidelines.

Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy

BACKGROUND

The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals.

METHODS

A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous.

RESULTS

A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines.

CONCLUSION

Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians.

The impact of provider knowledge and attitudes toward national asthma guidelines on self-reported implementation of guidelines

This study determines the impact of provider knowledge and attitude on implementation of guidelines: spirometry, peak flows, patient assessments, action plans, severity assessment, and anti-inflammatories. A self-administered survey conducted in academic family practice sites in Buffalo, NY assessed knowledge, self-reported use, and perceived usefulness. Knowledge was associated with regular use of peak flows (p = 0.048) and anti-inflammatories (p = 0.01). Positive attitude was associated with regular use of spirometry (p = 0.03), peak flows (p < or = 0.001), patient assessments (p = 0.02), action plans (p = 0.046), anti-inflammatories (p < or = 0.001), and severity assessment (p < or = 0.001). Perceived usefulness is critical to implementing asthma guidelines. Interventions to improve provider adherence must address attitude.