PURPOSE: The landmark AIA survey, conducted in 1998, included an assessment of treatment practices among a cross-section of 512 US physicians (44 pulmonologists, 76 allergists, 151 family or general practitioners, 108 internists, and 133 pediatricians) in relation to 1997 NAEPP guidelines. The NAEPP guidelines underwent a minor update in 2002 and a major update in 2007. We compared physician practices in the AIM survey, conducted in 2009, with similar data from the AIA survey.
METHODS: In the AIM survey, 309 US physicians, comprising 158 asthma care physicians (ACPs), including 54 pulmonologists and 104 allergists, and 151 primary care physicians (PCPs), including 101 family practitioners and 50 internists, were interviewed via telephone. Descriptive statistics, without formal testing, were used for comparing AIA and AIM results.
RESULTS: Nearly all ACPs (98% in both surveys) and slightly lower percentages of PCPs (88% in AIA vs 94% in AIM) were aware of NAEPP guidelines. Percentages of physicians adhering to guidelines “always” or “most of the time” decreased slightly between surveys for ACPs (96% in AIA vs 91% in AIM) and PCPs (80% in AIA vs 77% in AIM). However, strict adherence to guidelines (response of “always” follow) declined more, both for ACPs (53% in AIA vs 39% in AIM) and PCPs (31% in AIA vs 17% in AIM). Use of written asthma action plans for “all,” “most,” or “some” patients declined both among ACPs (91% in AIA vs 82% in AIM) and PCPs (72% in AIA vs 67% in AIM). Lung function testing was performed for diagnosis of asthma “always” by most ACPs (73% in AIA vs 76% in AIM), but few PCPs (27% in AIA vs 26% in AIM). Greater percentages of ACPs (88% in AIA vs 96% in AIM) and PCPs (68% in AIA vs 62% in AIM) repeated lung function testing to monitor their patients. Most physicians in both surveys prescribed peak flow meters to patients, although the percentages declined both for ACPs (94% in AIA vs 80% in AIM) and PCPs (84% in AIA vs 72% in AIM).
CONCLUSIONS: Awareness of NAEPP guidelines among physicians remained high between 1998 and 2009, but there was little improvement in adherence to guidelines or in implementation of asthma management practices. In both 1998 and 2009, ACPs treated patients with asthma more in accordance with guidelines than PCPs did.
CLINICAL IMPLICATIONS: Additional efforts to increase adherence to NAEPP guidelines by physicians are warranted, with the goals of improving asthma management and outcomes.
DISCLOSURE: Robert Nathan: Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, GlaxoSmithKline, Merck & Co.
Eli Meltzer: Grant monies (from industry related sources): Amgen, Boehringer Ingelheim, Merck & Co., Novartis, Schering-Plough, Sunovian,Teva, Consultant fee, speaker bureau, advisory committee, etc.: GlaxoSmithKline, Merck & Co., Schering-Plough, Sunovian
Michael Blaiss: Shareholder: ISTA Pharmaceuticals, Fiduciary position (of any organization, association, society, etc, other than ACCP: Treasurer-Respiratory Allergic Disorders Foundation (a non-profit), Consultant fee, speaker bureau, advisory committee, etc.: Merck, ISTA, Allergan, Genentech, GSK, AstraZeneca, Procter & Gamble, Meda, sanofi-aventis, Sunovion, Nycomed
Kevin Murphy: Grant monies (from industry related sources): AstraZeneca, Boehringer Ingelheim, Merck & Co., Novartis Pharmaceuticals, Schering-Plough, Fiduciary position (of any organization, association, society, etc, other than ACCP: Board Member of Attack on Asthma Nebraska, Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Dey, ISTA, Merck & Co., Novartis Pharmaceuticals, Schering-Plough, Sepracor
Dennis Doherty: University grant monies: Boehringer Ingelheim, Merck, Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Merck
Stuart Stoloff: Consultant fee, speaker bureau, advisory committee, etc.: Alcon, AstraZeneca, Boehringer Ingelheim, Dey, Genentech, GlaxoSmithKline, Merck, Sunovion, Teva
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