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• W2237218575 abstract "It has now been nearly a decade since the National Heart, Lung, and Blood Institute of the National Institutes of Health published recommendations for the diagnosis and treatment of asthma (1). While these guidelines underwent a modest updating in the late 1990s (2), their message has been consistent and clear. Asthma should be viewed as an inflammation of the airways rather than just a problem of airway hyperresponsiveness. Standardized routine assessment of the airways and clear disease classification of severity should be the foundation for planning. Early use of anti-inflammatory medications should be the treatment of choice for all but the mildest intermittent expression of the disease. Finally, a solid patient-provider partnership is needed to ensure appropriate asthma education, written action plans, and eventual self-management skills.The national guidelines have been widely disseminated, and a number of recent studies suggest that the vast majority of surveyed health care providers are aware of them (3–5). However, regardless of the widespread knowledge of these guidelines, mounting evidence indicates that physicians have not fully adopted them into practice (6–8). The article by Gipson et al provides additional evidence of the gap between the availability and use of asthma clinical care guidelines (9). The authors conducted chart audits to determine whether key processes related to asthma care were documented during routine patient visits. The authors report that many of the key elements of care were not routinely documented. They also note that although these performance measures appeared more frequently in the charts of asthma specialty clinics, even within that environment, there were clear opportunities to improve care. These findings, while interesting, are not all that unexpected. Several countries with well-established asthma care guidelines have documented (via chart audit) deficiencies in care for persons with asthma (10–12).While there is some merit to further characterizing the lack of guideline adherence and variations in physician practices, the clear challenge for those concerned with improving asthma care lies in changing physician behavior and practice performance. The information obtained from the audit process provides a valuable foundation for discussing ways to improve care. It is critical to search for opportunities to use audit information to provide feedback that will lead to improvements in practice performance and, ultimately, better patient outcomes.It is difficult to identify the most efficient mechanisms for achieving improvements in asthma care. There have been many attempts to encourage the adoption of practice guidelines and practice improvements; few have met the rigors of formal science. Yet there has been some demonstrated success in changing physician behavior through use of academic detailing, opinion leaders, physician feedback systems, and clinical decision support systems. These types of interventions, while useful to the individual physician, are perhaps best introduced through social learning networks such as community collaborations of providers focused on improving care (13).Several studies of the use of feedback of audit information have reported improvements in care for persons with asthma (14, 15). Therefore, perhaps the most important opportunity derived from the study by Gipson et al rests not in the knowledge that there are areas where asthma care should be improved, but rather that the findings from clinical audits like these should serve as a first step in the journey towards practice improvement." @default.
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• W2237218575 date "2000-10-01" @default.
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• W2237218575 title "Asthma Guidelines: Invited Commentaries" @default.
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• W2237218575 doi "https://doi.org/10.1080/08998280.2000.11927716" @default.
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