Primary Care Research

Lack of self-efficacy keeps inner-city primary care providers from following national asthma management guidelines

Although asthma is a common disease, rates are particularly high among minorities who live in inner-city neighborhoods. For example, East Harlem in New York City has hospitalization and mortality rates that are several times the national average. Yet, several barriers prevent health care providers in these areas from adhering to national asthma guidelines.

Researchers surveyed 202 primary care providers working in East Harlem at 3 large general medicine clinics located in hospitals and 1 large community-based practice. Specific questions addressed the provider's adherence to 5 asthma management practices recommended in guidelines developed by the National Heart, Lung, and Blood Institute (NHLBI): use of inhaled corticosteroids, peak flow monitoring, asthma action plans, allergy testing referrals, and influenza vaccination.

Among the providers surveyed, 70 percent were aware of the NHLBI guidelines. However, only 39 percent had actually read them, and 46 percent were using them to manage their asthma patients. Adherence to specific recommendations was highest for influenza vaccination (73 percent), the use of inhaled corticosteroids (62 percent), and peak flow monitoring (34 percent). There was little adherence among providers when it came to using asthma action plans (9 percent) and referring patients for allergy testing (10 percent).

The researchers also found several barriers that were significantly associated with poor adherence to the guidelines overall. One of the most important was the lack of self-efficacy among providers. Providers felt they did not have the ability or confidence to execute specific guideline recommendations. Other barriers included not being fully familiar with the guidelines and the expectation that patients would not adhere to the various activities called for.

The researchers indicate that increased efforts are needed to bridge the gap between actual care and knowledge of the recommendations. The study was supported in part by the Agency for Healthcare Research and Quality (HS13312).

See "Barriers to adherence to asthma management guidelines among inner-city primary care providers," by Juan P. Wisnivesky, M.D., M.P.H., Jessica Lorenzo, M.P.H., Richard Lyn-Cook, M.D., M.P.H., and others, in the September 2008 Annals of Allergy, Asthma & Immunology 101, pp. 264-270.

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