Improving Quality of Care and Guideline Adherence for Asthma Through a Group Self-Assessment Module

Kurt Elward; Brenna Blackburn; Lars E. Peterson; Mark Greenawald; Michael D. Hagen

doi:10.3122/jabfm.2014.03.130241

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Table 1. Personal Characteristics of Group Self-Assessment Module (SAM) Participants from Virginia Versus All American Board of Family Medicine Physicians

Characteristics	Group Asthma SAM Participants (n = 38)	Virginia Family Physicians (n = 2812)
Age (years)	50.9 (7.7)	50.3 (10.5)
Years practicing	19.7 (8.7)	17.9 (11.1)
Total MC-FP modules completed	5.5 (2.3)	4.4 (3.1)^*
SAMs completed	3.9 (1.9)	3.6 (2.4)
PPMs completed	1.7 (0.9)	0.8 (0.9)^*
Last primary exam score	557.9 (87.0)	512.5 (93.1)^*
Male sex	55.3	62.1
MD degree	97.4	93.5
Currently board certified	97.4	90.3

Data are means (standard deviations) or percentages.
↵* P < .05.
MC-FP, Maintenance of Certification for Family Physicians; PPM, Performance in the Practice of Medicine module.

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Table 2. Physicians' Abstracted Adherence to Asthma Guidelines Before and 6 Months After a Group Self-Assessment Module (SAM)

	Before SAM	6 Months after SAM
Diagnosed according to NAEPP criteria	48.3	80.2^*
ACT or ATAQ used at last asthma visit	11.2	53.3^*
Planned asthma visit in the past year	50.7	75.0^*
Asthma action plan in chart	8.1	54.1^*
Controller medication prescribed for persistent asthma	75.7	80.4
ICS	32.1	48.7^*
LTA	29.5	28.1
ICS/LABA combination	58.5	56.3

↵* P < .05.
ACT, Asthma Control Test; ATAQ, Asthma Therapy Assessment Questionnaire; ICS, inhaled corticosteroid; LABA, long-acting β-agonist; LTA, leukotriene agonist; NAEPP, National Asthma Education and Prevention Program.

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Table 3. Physician-Reported Assessment and Perceptions of Asthma Treatment Guidelines Before, Immediately After, and 6 Months After a Group Self-Assessment Module (SAM)^*

Statement	Agreement	Before SAM (n = 39)	Immediately after SAM (n = 39)	6 Months after SAM (n = 32)
Inhaled steroids are recommended for all persistent asthmatics	Agree	89.5	100	100^{^†}
The approach to severity assessment is clear for me.	Agree	55.3	100	86.2^{^†}
There are four steps in the asthma classification system: mild intermittent, moderate intermittent, moderate persistent and severe persistent.	Disagree	47.4	84.2	59.4^{^†}
I feel comfortable with my ability to assess control as recommended in the guidelines.	Agree	47.4	82.1	97.8^{^†}

↵* Before SAM indicates the initial assessment of EPR-3 guidelines. Immediately after SAM and 6 months after SAM indicate questions related to perceptions of the NHLBI asthma guideline recommendations and format.
↵† P < .05.
EPR-3, Expert Panel Report 3; NHLBI, National Heart, Lung, and Blood Institute.

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Table 4. Physician-Reported Challenges in Delivering Asthma Care Before Participation in the Group Self-Assessment Module (SAM) (n = 38)

Major Challenges That Are Never or Rarely a Problem	Respondents (%)
Assessment of severity	31.6
Assessment of control (eg, using ACT or ATAQ)	18.4
Planned visits	23.7
Use of action plans	7.9
Environmental assessment	18.4
Use of inhaled steroids for persistent asthma	81.6
Making the diagnosis	62.5
Allergy evaluation	42.1
Time constraints for evaluation	21.0
Treatment grids	39.5
Referral criteria	63.2

* P < .05.
ACT, Asthma Control Test; ATAQ, Asthma Therapy Assessment Questionnaire.

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Table 5. Physician-Reported Confidence in and Likelihood of Providing Guideline-Adherent Asthma Care After Participation in a Group Self-Assessment Module (SAM)

	Agreement	Immediately after SAM (n = 38)	6 Months after SAM (n = 32)
The SAM helped me feel more confident in this area.
Assessment of severity	Agree/strongly agree	100	93.8
Assessment of control (eg, using ACT or ATAQ)	Agree/strongly agree	94.7	96.9
Planned visits	Agree/strongly agree	100	90.6
Use of action plans	Agree/strongly agree	94.7	75.0^*
Environmental assessment	Agree/strongly agree	94.7	80.7
Use of inhaled steroids for persistent asthma	Agree/strongly agree	100	100
Making the diagnosis	Agree/strongly agree	92.1	93.8
Allergy evaluation	Agree/strongly agree	96.8	71.0
Time constraints for evaluation	Agree/strongly agree	67.6	65.6
Treatment grids	Agree/strongly agree	96.8	84.4
At the end of this SAM, how likely were you to:		Immediately after SAM (n = 38)	6 Months after SAM (n = 25)
Use inhaled corticosteroids as the preferred controller agent for treatment	Likely/very likely	100	100
Begin planned asthma visits for patients with persistent asthma	Likely/very likely	100	92.0
Assess severity based on EPR-3 criteria	Likely/very likely	92.1	96.0^*
Assess control using the ACT or ATAQ	Likely/very likely	94.7	88.0^*
Refer for allergy evaluation	Likely/very likely	84.2	80.0
Seek an environmental assessment for persistent asthmatics	Likely/very likely	89.5	84.0