How closely does the care of asthmatic children at an inner city family medicine practice match the 1997 national asthma education and prevention (NAEPP) guidelines?☆

Abstract 

Rationale

Evidence exists that the 1997 NAEPP Guidelines have limited effect on decreasing morbidity and increasing quality of life of asthmatic children, perhaps due to lack of adherence to guideline recommendations among providers. We assessed perceptions of and actual adherence to guidelines among primary care providers.

Methods

Retrospective chart review of 100, randomly selected asthmatic children (222 visits and 2.2/child) ages 5–18, with at least one asthma-coded clinic visit between January 2000 and January 2003. 26 Family Practitioner (72% response rate) faculty and residents were surveyed about their asthma knowledge, attitudes and agreement with the guidelines.

Results

Sample included 100 primarily 11 year old males (67%), Hispanic (51%), inner-city residents (69%), receiving Medicaid (76%). Chart review revealed documentation of: a) severity for 64% of children, 54% of visits, b) written action plans for 5% of children, c) medication adherence in 22% of visits, d) f/u visit in 54% of visits, e) allergy testing for 19% of persistent asthmatics, f) prior year influenza for 37% of children, g) inhaled steroid therapy for 88% of charts of children. Survey revealed 31% of practitioners never heard of the Guidelines, 73% were confident they followed Guidelines and most generally supported Guideline asthma care principles. Attendings (A) and residents (R) differed in their opinions about the guidelines regarding usefulness (97% A, 60% R, p=0.02).

Conclusions

There is a gap between practitioners' perceptions of guideline adherence and their actual practice patterns. Closing the gap between perception and reality may improve the quality of pediatric asthma care.

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