Current Outpatient Management of Asthma Shows Poor Compliance With International Consensus Guidelines

Taylor, David; Auble, Thomas E.; Calhoun, William J.; Mosesso, Vincent N.

doi:10.1378/chest.116.6.1638

Cited by 83 publications

(62 citation statements)

References 27 publications

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“…Such activities are often initiated by DTCs and have been shown to impact more on prescribing patterns when they are local and built on personal relations [50]. In addition, a combination of activities enhances the chances of success [15,49,51]. Taylor et al showed that it is important that the patients have received adequate information on their asthma disease, drug regimens, and inhaler technique [51].…”

Section: Regional Variations and Adherence To National Guidelinesmentioning

confidence: 99%

“…In addition, a combination of activities enhances the chances of success [15,49,51]. Taylor et al showed that it is important that the patients have received adequate information on their asthma disease, drug regimens, and inhaler technique [51]. It may be in this situation that activities need to be targeted at both patients and physicians to encourage the prescribing on an ICS first before a LABA, especially if there are continued fears about steroid use.…”

Section: Regional Variations and Adherence To National Guidelinesmentioning

confidence: 99%

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Regional variation and adherence to guidelines for drug treatment of asthma

Arnlind¹,

Wettermark²,

Nokela³

et al. 2009

Eur J Clin Pharmacol

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Aims To describe the utilization of antiasthmatic drugs in Sweden and to explore regional variations in drug utilization and adherence to guidelines for rational drug prescribing of antiasthmatics and their rationale. Methods Data on antiasthmatic drugs dispensed between July 2005 and December 2008 to all Swedish citizens aged between 18 and 44 years were obtained from the Swedish National Prescribed Drug Register. The period prevalence was determined by analyzing the number of users/1000 inhabitants, and the incidence by analyzing the number of new users after an 18-month drug-free wash-out period. Three drug-related indicators were used to assess the adherence to guidelines. All measures were analyzed by gender and region. Results A total of 161,000 patients were dispensed antiasthmatics in 2007, corresponding to a prevalence of 4 and 6% among men and women, respectively; the incidence rates were 2 and 3%, respectively. The total drug utilization and adherence to guidelines varied between regions. The total drug expenditures of antiastmatics were 258 million SEK (28 million euro), with fixed dose combinations accounting for 46% of the expenditure. No relation was found between models for allocating prescribing budgets or clear Drug and Therapeutics Committee recommendations and adherence to guidelines. Conclusion There are large regional variations in the utilization of antiasthmatics between Swedish regions, with substantial room for improvement in the adherence to guidelines. New methods of influencing physician behavior may be needed in the future to enhance adherence.

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Section: Regional Variations and Adherence To National Guidelinesmentioning

confidence: 99%

Section: Regional Variations and Adherence To National Guidelinesmentioning

confidence: 99%

Regional variation and adherence to guidelines for drug treatment of asthma

Arnlind¹,

Wettermark²,

Nokela³

et al. 2009

Eur J Clin Pharmacol

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“…In order to detect a difference in HRQL of 0.5, o63 patients with adherent and 63 with nonadherent treatment regimes were required. Previous work clinically assessing asthma treatment found the proportion of patients with pharmacotherapy not adherent to that recommended in the guidelines to be y60% [2,7]. Thus, the study aimed to recruit 160 patients in order to achieve a power of 0.80 with an alpha of 0.05.…”

Section: Sample Sizementioning

confidence: 99%

“…Little attention has been given to the effect of guidelines on patient outcomes, such as mortality, morbidity or quality of life in asthma. Prescriber adherence to the asthma guidelines with respect to diagnostic procedures, drug therapy and patient self-management counselling has been investigated [2,[6][7][8]. While explicit guidelines have been shown to improve physician clinical practice, it is not known if such improvement has similar positive effects on patient outcomes [9,10].…”

mentioning

confidence: 99%

Relationship between guideline treatment and health-related quality of life in asthma

Pont¹,

Molen²,

Denig³

et al. 2004

Eur Respir J

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The aim of this study was to compare the health-related quality of life (HRQL) of asthma patients treated according to the 1997 National Institute of Health (NIH) international asthma guideline and that of asthmatics receiving non-guideline treatment.The suitability of 146 asthmatics9 medication regimes was determined according to the 1997 NIH asthma guideline. Quality of life was assessed on a seven-point scale using the Asthma Quality of Life questionnaire.Just over half of the patients were not currently using the treatment considered necessary for controlling their asthma. Patients treated according to the guideline (n=72) had a significantly higher overall HRQL than patients with non-guideline treatment (5.7 versus 5.3). The differences were also significant for the subscales measuring symptoms and environmental exposure, but not for activities or emotional function.An association between non-guideline treatment and a poorer health-related quality of life in asthma patients treated in general practice was observed. This study supports the role of evidence-based guidelines in daily practice. Further studies are needed to determine if guideline treatment is responsible for the increase in health-related quality of life observed in this work. Eur Respir J 2004; 23: 718-722.

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“…Much evidence exists that supports the relationship between practitioner adherence to guidelines and positive clinical and financial outcomes. [9][10][11][12][13][14][15][16][17] However, studies [1][2][3][4][5][6] to date demonstrate that practitioner adherence with core recommendations within practice guidelines is inconsistent and highly variable.…”

mentioning

confidence: 99%