Original Articles: Asthma, Lower Airway DiseasesBarriers to adherence to asthma management guidelines among inner-city primary care providers
Section snippets
INTRODUCTION
Asthma is a common disease with an overall prevalence in the general population of 6% to 7%.1, 2 Minority, inner-city residents have disproportionately high rates of asthma incidence and increased morbidity and mortality.1, 2, 3, 4 This problem is especially serious in East Harlem, a community with asthma hospitalization and mortality rates that are several times higher than the national average.5 Proposed explanations for the urban asthma problem include patient-provider communication
Study Population
Our study population was health care providers who practiced at 3 large hospital-based general medicine clinics and 1 large community-based practice in East Harlem in New York, New York. Eligible providers were those engaged in direct patient care at 1 of these clinics whose usual patient population included adult asthmatic patients. Pediatricians, pulmonary specialists, and allergy specialists were excluded. Primary care providers were identified from the clinic rosters. Physicians in training
RESULTS
Of the 296 primary care providers offered participation in the study, 223 (75%) completed the survey. Twenty-one surveys (9%) were excluded because more than 50% of the responses were missing, leaving 202 surveys available for analysis. Table 1 gives the baseline sociodemographic characteristics of the participating providers. Consistent with other hospital-based primary care clinics, most providers (79%) in the study were residents receiving training. Despite the fact that Hispanics are more
DISCUSSION
Asthma is a common chronic medical condition that causes considerable morbidity and mortality among minority inner-city populations.5, 7, 25, 26, 27, 28, 29 Although the origin of this problem is likely multifactorial, suboptimal quality of care is an important factor that contributes to poor outcomes among urban asthmatic patients. This study evaluated potential barriers to clinician adherence to the NHLBI guidelines, one of the most widely accepted references for evidence-based asthma care
ACKNOWLEDGMENTS
We thank Nicky O’Connor, Amy Carney, Jessica Segni, and Julian Baez, from the Mount Sinai School of Medicine, whose help was invaluable to this study, as well as all the providers who completed the survey.
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Disclosures: Authors have nothing to disclose.
Funding Sources: This study was funded by the Agency for Healthcare Research and Quality (K08 HS013312, Dr Wisnivesky) and the National Institute on Aging (RO1 HS09973). Dr Lyn-Cook was supported by the Empire Clinical Research Investigators Program, New York State Department of Health.