National Asthma Education and Prevention Program (NAEPP) guidelines recommend therapy based on structured severity stratifications for each patient, and written action plans with self-monitoring of peak flows. Nevertheless, many patients do not receive guideline-based care. This study surveyed physicians treating asthma patients to identify significant differences in guidelines-based care across specialties.
A 4-page survey (with a $1 response-incentive) was mailed to 3,000 physicians, representing a random sample of those treating patients enrolled in a large asthma disease management program.
Responses from 348 physicians were received, representing 17% general internists, 41% family physicians, 18% pediatricians, 9% pulmonologists, 11% allergists, and 4% alternate specialties.High familiarity with the NAEPP guidelines was reported significantly more often by pulmonologists (84%, p<0.0001), allergists (95%, p<0.0001), and pediatricians (74%, p<0.0001), compared with all other physicians (42%).High familiarity with NAEPP severity subtypes was also reported more often by pulmonologists (84%, p<0.0001), allergists (95%, p<0.0001), and pediatricians (75%, p<0.0001), compared with all other physicians (42%).Use of these NAEPP severity classifications to guide patient management for more than 60% of asthma visits was reported more often by pulmonologists (65%, p<0.0001), allergists (74%, p<0.0001), and pediatricians (66%, p<0.0001), compared with all other physicians (35%).Overall, half of respondents reported providing written action plans to less than 20% of their asthma patients, although allergists reported providing action plans to a significantly higher percentage than other physicians. Pulmonologists and allergists also reported providing instructions on proper inhaler device use to substantially more patients than other physicians.CONCLUSIONS: Awareness and adoption of the NAEPP’s key clinical recommendations is suboptimal. Pulmonologists, allergists, and pediatricians report significantly greater awareness and adoption of these recommendations.
Tailored educational efforts and process improvements are needed to achieve the goal of increased physician compliance with the NAEPP recommendations for high-quality asthma care.
R.A. Feifer, Schering-Plough, Grant monies.