Compliance with US asthma management guidelines and specialty care: a regional variation or national concern?

The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eight health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross‐sectional sur...

Full description

Saved in:
Bibliographic Details
Published in:Journal of evaluation in clinical practice 1999-05, Vol.5 (2), p.213-221
Main Authors: Meng, Ying-Ying, Leung, Kwan-Moon, Berkbigler, Dale, Halbert, Ronald J., and, ., Legorreta, Antonio P.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
asthma
Asthma - therapy
compliance
concern
Female
Guideline Adherence
guidelines
Humans
Male
Middle Aged
Patient Compliance
Practice Guidelines as Topic
Socioeconomic Factors
United States
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eight health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross‐sectional survey in a managed care environment. The participants were 6703 respondents (ages 14–65) with moderate or severe asthma. The main outcome measures were compliance with the NAEP guidelines on the use of inhaled steroids, inhaled beta2‐agonists, peak flow measurement, and allergy evaluations. Among the results of this survey we found that although these health plans are located from the West Coast to the East Coast and the socioeconomic status of their members varied greatly, compliance with the NAEP guidelines was low among asthmatic members across all geographical regions. The major areas of low compliance identified were inappropriate pharmacological therapy, lack of objective measurement of lung function through peak flow meter, and insufficient environmental trigger control. The regression analyses indicated that the effect of the health plan explained little of the variation in compliance across these regions (only 0.3% at maximum). Low compliance was associated with young age, smoking, moderate asthma, being asthmatic for a few years, currently working, and being treated by a generalist rather than a specialist. In conclusion, this study showed that the compliance with the national guidelines for asthma care was consistently low across different geographical regions in the nation. Improvement in care for asthmatics will require greater commitment and involvement by all stakeholders including physicians, patients, health plans, and employers. We suggest a need for a national strategy to disseminate clinical guidelines not only to the medical community but also to patients themselves.
ISSN:1356-1294
1365-2753
DOI:10.1046/j.1365-2753.1999.00177.x