Self-reported physician practices for children with asthma: Are national guidelines followed?

Jonathan A. Finkelstein, Paula Lozano, Reeva Shulruff, Thomas Inui, Stephen B. Soumerai, Mitzi Ng, Kevin B. Weiss

Research output: Contribution to journalArticle

208 Citations (Scopus)

Abstract

Objective. To determine self-reported adherence to national asthma guidelines for children by primary care physicians in managed care; and, to analyze sources of variation in these practices by physician specialty and managed care practice type. Design. A survey of 671 primary care physicians (pediatricians and family physicians) practicing in 3 geographically diverse managed care organizations (MCO). Domains of interest included asthma diagnosis, pharmacotherapy, patient education and follow-up, and indications for specialty referral. Item formats included self-reports of usual practice and responses to case vignettes. Results. A total of 429 (64%) physicians returned surveys, 22 of whom did not meet criteria for inclusion in the analysis. Most respondents had both heard of (91%) and read (72%) the National Asthma Education and Prevention Program (NAEPP) guidelines. For diagnosis, 75% reported routine use of office peak flow measurement, but only 21% used spirometry routinely. Family physicians were more likely than pediatricians to use spirometry in diagnosis (odds ratio [OR] = 5.9), and less likely to recommend daily peak flow measurement (OR = .3). The median reported frequency of providing written care plans was only 50%. Though inhaled carticosteroids were deemed very safe or safe by 93%, almost half had specific concerns regarding at least 1 side effect, most commonly growth delay. Primary care physicians' criteria for referral to an asthma specialist differed from those of the NAEPP panel in choosing to manage more severe patients without asthma specialist input. Family physicians were more likely than pediatricians to refer a child after a single hospitalization, 2 to 3 emergency department visits, after 2 exacerbations, or if the child was

Original languageEnglish (US)
Pages (from-to)886-896
Number of pages11
JournalPediatrics
Volume106
Issue number4 II SUPPL.
StatePublished - 2000
Externally publishedYes

Fingerprint

Asthma
Guidelines
Physicians
Family Physicians
Managed Care Programs
Primary Care Physicians
Spirometry
Referral and Consultation
Odds Ratio
Education
Patient Education
Child Care
Self Report
Hospital Emergency Service
Hospitalization
Organizations
Drug Therapy
Growth
Surveys and Questionnaires
Pediatricians

Keywords

  • Asthma
  • Managed care organizations
  • Practice guidelines
  • Primary care physicians

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Finkelstein, J. A., Lozano, P., Shulruff, R., Inui, T., Soumerai, S. B., Ng, M., & Weiss, K. B. (2000). Self-reported physician practices for children with asthma: Are national guidelines followed? Pediatrics, 106(4 II SUPPL.), 886-896.

Self-reported physician practices for children with asthma : Are national guidelines followed? / Finkelstein, Jonathan A.; Lozano, Paula; Shulruff, Reeva; Inui, Thomas; Soumerai, Stephen B.; Ng, Mitzi; Weiss, Kevin B.

In: Pediatrics, Vol. 106, No. 4 II SUPPL., 2000, p. 886-896.

Research output: Contribution to journalArticle

Finkelstein, JA, Lozano, P, Shulruff, R, Inui, T, Soumerai, SB, Ng, M & Weiss, KB 2000, 'Self-reported physician practices for children with asthma: Are national guidelines followed?', Pediatrics, vol. 106, no. 4 II SUPPL., pp. 886-896.
Finkelstein JA, Lozano P, Shulruff R, Inui T, Soumerai SB, Ng M et al. Self-reported physician practices for children with asthma: Are national guidelines followed? Pediatrics. 2000;106(4 II SUPPL.):886-896.
Finkelstein, Jonathan A. ; Lozano, Paula ; Shulruff, Reeva ; Inui, Thomas ; Soumerai, Stephen B. ; Ng, Mitzi ; Weiss, Kevin B. / Self-reported physician practices for children with asthma : Are national guidelines followed?. In: Pediatrics. 2000 ; Vol. 106, No. 4 II SUPPL. pp. 886-896.
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