Chest

Chest

Volume 116, Supplement 2, October 1999, Pages 145S-154S
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Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Primary-Care Physicians

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Methods

In 1997, a self-administeredsurvey was mailed to a randomly selected 10% sample of Chicago-areageneral pediatricians, internists, and family practitioners.

Results

Surveys were returned by 244 of the 405eligible Chicago-area primary-care physicians (60.2%) in the sample. Of these, 66 (27.6%) were pediatricians, 83 (34.7%) were generalinternists, and 90 (37.7%) were family practitioners. Physiciansreported that 54.6 ± 2.7% (mean ± SE) of patients withnewly diagnosed asthma have spirometry performed as part of theirinitial evaluation. For patients with moderate persistentasthma, prescribing of inhaled corticosteroids varied by patientage, with 60.5% of physicians routinely prescribing them for patients< 5 years, compared with 95.7% of physicians prescribing them forpatients ≥ 5 years. Awareness of the NAEPP guide-lines amongthese physicians was high, with 88.5% reporting that they have heardof the guidelines, and 73.6% reporting having read them. Of patientswith moderate or severe persistent asthma, physicians estimated that47.7 ± 2.7% were given written treatment plans.

Conclusion

Several aspects of the NAEPP guidelines appearto have been incorporated into clinical practice by Chicago-areaprimary-care physicians, whereas other recommendations do not appear tohave been readily adopted. This information suggests areas forinterventions to improve primary care for asthma in the Chicagoarea.

Section snippets

Overview of Study Design

A single-period, cross-sectional written survey was used to assess the delivery of asthma care by primary-care physicians in the Chicago area.

Survey Instrument

A self-administered instrument was constructed on the basis of surveys developed by the National Heart, Lung, and Blood Institute,12 the Quality Assurance Reform Initiative project of the National Committee on Quality Assurance,13 and the Managed Health Care Association.14 The survey addressed (1) asthma diagnosis; (2) clinical monitoring of asthma

Results

Surveys were completed by 244 of the 405 eligible Chicago-area primary-care physicians, for a response rate of 60.2%. Twenty-five of these surveys were excluded because responding physicians reported that asthma patients constituted < 1% of their practice; this left 219 surveys for the final analysis.

Discussion

Among the Chicago-area primary-care physicians responding to the survey, awareness of the NAEPP asthma guidelines was high, suggesting that the dissemination efforts of the National Heart, Lung, and Blood Institute were largely successful in this community. Nearly all the physicians who reported having read the guidelines also found them to be useful. In addition, most of the physicians surveyed reported recent participation in other asthma-related educational programs.

Consistent with these

Conclusion

Although the high self-reported compliance with NAEPP guidelines among primary-care physicians in the Chicago area may seem comforting, many concerns about asthma care remain. This study highlights several areas of significant differences between the expert-driven guidelines and normative primary care. A greater understanding of the reasons for these differences would be of practical importance in promoting guideline acceptability and adaptation. Also, it is important to consider how

Appendix

Other members of the CASI team include (in alphabetical order): Claudia Baier, MPH, Edward Eckenfels, Tao Li, PhD, Christopher Lyttle, MA, and Anita Malone, MPH, of Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL; and Michael McDermott, MD, of Cook County Hospital, Chicago, IL.

ACKNOWLEDGMENTS

The authors thank the following members of the CASI primary-care survey advisory group for their thoughtful review of the survey instrument: Richard Abrams, MD, Myron Berman, MD, Diane DiMaggio, MD, Richard Lord, MD, James Mitchell, MD, and Michael O'Mara, MD. We also thank Ms. Julie Piorkowski for her research assistance in the early phases of this project and Ms. Robin Wagner for her assistance in manuscript preparation.

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    • Cited by (0)

    The Chicago Asthma Surveillance Initiative (CASI) is funded by a grantfrom the Otho S.A. Sprague Memorial Institute.

    †

    See Appendix for other members of the CASI Project Team

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    Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.