Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: Qualitative comparative case study in primary care

Wiener-Ogilvie, Sharon; Huby, Guro; Pinnock, Hilary; Gillies, John; Sheikh, Aziz

doi:10.1186/1471-2296-9-32

Cited by 33 publications

(32 citation statements)

References 18 publications

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“…This, coupled with the Medicare rebate system, means that practice nurses in Australia do not usually take on spirometry and other aspects of asthma diagnosis as they do in well-organised practices in the UK. 18 The patient characteristics that influence the likelihood of receiving a diagnosis of asthma may be related to their willingness to know. There are likely to be some patients with signs and symptoms of asthma who do not mention it to their GP for a variety of reasons.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Dennis

Zwar

Marks

2009

Primary Care Respiratory Journal

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Aim: To explore what difficulties are faced by general practitioners (GPs) when trying to make a diagnosis of asthma in adults, and whether there are patient characteristics that influence this process.Methods: A qualitative study in which three focus group discussions were conducted with 18 GPs.Results: GPs were confident with the components needed to confirm a diagnosis of asthma but not with the use of spirometry. GPs said that time was an important factor -time to undertake the tests in their practice, and time to persuade the patient to engage in the diagnostic process including follow-up visits. Patients who were less willing to engage in this process were likely to be treated symptomatically.Conclusion: Continuity of care is important. A diagnosis of asthma seems to be more likely in patients with an ongoing relationship with their GP where both are willing to engage in the diagnostic process.

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Section: Discussionmentioning

confidence: 99%

Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Dennis

Zwar

Marks

2009

Primary Care Respiratory Journal

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“…In order to gain better acceptance of chronic respiratory diseases guidelines in primary care, there is a need for the development of guidelines with intense involvement of GPs. Some of the reasons why GPs do not always implement guidelines are: inadequate organisation in practice; 49 scepticism about the effectiveness of guidelines; 50 and/or the difficulty of GPs to cope with evidence-based medicine in day-to-day practice. 50 Since clinical management following evidence-based guidelines yields better results for patients, 7,45 it is important to have access to primary care guidelines which are specifically relevant to, and provided by, primary care.…”

Section: Use Of Rhinitis Guidelines At the Primary Care Levelmentioning

confidence: 99%

Guidelines for allergic rhinitis need to be used in primary care

Costa

Bousquet

Ryan

et al. 2009

Primary Care Respiratory Journal

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Clinical Practice Guidelines for allergic rhinitis have been developed over the past 15 years and have been found to improve the care for patients with allergic rhinitis. The ARIA (allergic rhinitis and its impact on asthma) guideline was the first of these evidenced-based guidelines, developed with primary care physicians. Subsequent guidelines include those by the IPCRG, BSACI, the AAAAI/ACAAI Practice Parameters for the diagnosis and management of rhinitis, and the ARIA 2008 Update. These guidelines were based on various evidencebased models, but the first to use GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation) is the ARIA 2009 Revision. Since primary care physicians treat the majority of patients with allergic rhinitis it is essential that they are involved in the development and implementation of guidelines for allergic rhinitis. Prior to their implementation, guidelines should be evaluated for their accuracy and user friendliness -specifically for primary care physicians -but such validation is rarely performed. This is of great importance, in particular as regards evaluating the applicability of evidence from high quality randomised controlled trials (RCTs) which are often based on highly selected patients not representing the population of patients seen in day-to-day practice.

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“…As early as in 1999, the European Respiratory Society (ERS) together with European Academy of Allergy and Clinical Immunology (EAACI) and GINA addressed these issues with the aim of obtaining effective strategies to better disseminate and implement guidelines [46]. The reasons for poor guideline adherence are generally multiple [47]. A number of different factors that influence GPs' prescribing patterns have been previously described [46,48,49].…”

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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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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Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: Qualitative comparative case study in primary care

Cited by 33 publications

References 18 publications

Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Guidelines for allergic rhinitis need to be used in primary care

Regional variation and adherence to guidelines for drug treatment of asthma

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