Asthma in Primary Care: Making Guidelines Work

Abstract

Asthma guideline developers and those interested in enhancing compliance with recommendations will need to attend to factors such as physician attitudes and beliefs on a variety of issues, including the use of objective measures and the availability of adequate resources to conduct the tests. Similarly, negative patient attitudes toward an increased use of corticosteroids suggest that a public education program would be most helpful regarding that group of recommendations.

Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines

“…The reason for these exclusions was the belief that the authors' findings were not consistent with or reflective of the data presented. The remaining 12 studies were published between 1998 and 2006, [25][26][27][28][29][30][31][32][33][34][35][36] and were all published in English (Supplementary Table 2). Five of the studies were from the UK, while the remaining seven were from the US, Canada, and the Netherlands.…”

“…[24][25][26][27][28][29][30][31][32][33][34][35] Studies indicated that some GPs were sceptical about the evidence…”

“…[25][26][27]29,30,33,35 GPs also pointed out that the use of narrow inclusion criteria could weaken the applicability of the evidence from trials. Cranney GPs expressed uncertainty about the evidence base in the face of changes over time and controversies.…”

“…25,34,35 They also suggested that there could be a conflict between the aims of the guidelines and the motivations of GPs; the former relating to cost containment, the latter relating to patient care. 25,29,30,35,36 Guideline authorship influenced the credibility of guidelines, 25,27,28,32,[34][35][36] and GPs tended to be more positive towards guidelines authored by peers or approved of in the local medical community as Pathman et al 28 found:…”

Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?

“…18,20,21 Lack of engagement with evidence and guidelines suggests a need for an increased primary care research base to inform guideline development.…”