A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice
Jessica K. Roydhouse A , Smita Shah B H , Brett G. Toelle C , Susan M. Sawyer D , Craig M. Mellis E , Tim P. Usherwood F , Peter Edwards G and Christine R. Jenkins CA Sydney Nursing School, CNRU, University of Sydney, Sydney, NSW 2006, Australia.
B Primary Health Care Education and Research Unit, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia.
C Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia.
D Department of Paediatrics, The University of Melbourne, and Murdoch Children’s Research Institute, Melbourne, Vic. 3052, Australia.
E Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
F Department of General Practice, Sydney Medical School – Western, University of Sydney, Sydney, NSW 2006, Australia.
G Holroyd Medical Practice, Merrylands, NSW 2160, Australia.
H Corresponding author. Email: smita_shah@wsahs.nsw.gov.au
Australian Journal of Primary Health 17(3) 288-293 https://doi.org/10.1071/PY11009
Submitted: 28 January 2011 Accepted: 21 March 2011 Published: 5 September 2011
Abstract
The prevalence of asthma in Australia is high. Previous findings have suggested that asthma management, particularly in primary care, remains suboptimal and recent government initiatives to improve asthma management and encourage the use of written asthma action plans (WAAPs) in general practice have been implemented. We aimed to assess the attitudes, confidence and self-reported paediatric asthma management practices of a convenience sample of Australian general practitioners (GPs). A baseline questionnaire was administered to GPs as part of a randomised controlled trial. General practitioners (GPs) were recruited from two areas of greater metropolitan Sydney, NSW between 2006 and 2008. Invitations were sent to an estimated 1200 potentially eligible GPs. Of 150 (12.5%) GPs that enrolled, 122 (10.2%) completed the baseline questionnaire. Though 89% were aware of the Australian National Asthma Guidelines, less than 40% were familiar with guideline recommendations. While 85.2% had positive attitudes towards WAAPs, only 45.1% reported providing them frequently. For children with frequent symptoms, 90% agreed they should prescribe daily, inhaled corticosteroids (ICS), and 83% reported currently prescribing ICS to such patients. These findings indicate gaps between GP attitudes and behaviours and highlights opportunities for interventions to improve paediatric asthma management.
References
Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz HH (2007) Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. The Journal of Antimicrobial Chemotherapy 60, 638–644.| Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXpt1Cmu7Y%3D&md5=0cca917ab1253b28e48e247f2e97f2faCAS |
Australian Centre for Asthma Monitoring (2008) ‘Asthma in Australia 2008.’ (Australian Institute for Health and Welfare: Canberra, ACT)
Barton C, Proudfoot J, Amoroso C, Ramsay E, Holton C, Bubner T, Harris M, Beilby J (2009) Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines. Primary Care Respiratory Journal 18, 100–105.
British Thoracic Society, Scottish International Guidelines Network (2009) ‘British guideline on the management of asthma: a national clinical guideline.’ (British Thoracic Society: London, Scottish International Guidelines Network: Edinburgh)
Britt H, Miller G, Charles J, Henderson J, Bayram C, Harrison C, Valenti L, Fahridin S, Pan Y, O’Halloran J (2008) ‘General practice activity in Australia 2007–08.’ (Australian Institute for Health and Welfare: Canberra, ACT)
Clark NM, Gong M, Schork MA, Evans D, Roloff D, Hurwitz M, Maiman L, Mellins RB (1998) Impact of education for physicians on patient outcomes. Pediatrics 101, 831–836.
| Impact of education for physicians on patient outcomes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3jt1Ghug%3D%3D&md5=cbdbb99df5bc01da892fc35e90508a7aCAS |
Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH (2003) Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews CD001117
Goeman DP, Hogan CD, Aroni RA, Abramson MJ, Sawyer SM, Stewart K, Sanci LA, Douglass JA (2005) Barriers to delivering asthma care: a qualitative study of general practitioners. The Medical Journal of Australia 183, 457–460.
Haby MM, Powell CV, Oberklaid F, Waters EB, Robertson CF (2002) Asthma in children: gaps between current management and best practice. Journal of Paediatrics and Child Health 38, 284–289.
| Asthma in children: gaps between current management and best practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zotlCltA%3D%3D&md5=36b71b3f4b8287ff378a0c827a5474c9CAS |
Hordacre A-L, Keane M, Kalucy E, Moretti C (2006) ‘Making the connections: report of the 2004–2005 annual survey of divisions of general practice.’ (Primary Health Care Research and Information Service: Adelaide, SA)
International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee (1998) Worldwide variation in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 351, 1225–1232.
| Worldwide variation in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC.Crossref | GoogleScholarGoogle Scholar |
Janson S, Weiss K (2004) A national survey of asthma knowledge and practices among specialists and primary care physicians. The Journal of Asthma 41, 343–348.
| A national survey of asthma knowledge and practices among specialists and primary care physicians.Crossref | GoogleScholarGoogle Scholar |
Jin R, Choi BC, Chan BT, Mcrae L, Li F, Cicutto L, Boulet LP, Mitchell I, Beveridge R, Leith E (2000) Physician asthma management practices in Canada. Canadian Respiratory Journal 7, 456–465.
Lougheed MD, Lemiere C, Dell SD, Ducharme FM, Fitzgerald JM, Leigh R, Licskai C, Rowe BH, Bowie D, Becker A, Boulet LP (2010) Canadian Thoracic Society asthma management continuum–2010 consensus summary for children six years of age and over, and adults. Canadian Respiratory Journal 17, 15–24.
Montano DE, Phillips WR (1995) Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. American Journal of Public Health 85, 795–800.
| Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M3ot12msQ%3D%3D&md5=89c65b763cc2ffac0aada3b4e91ffdfbCAS |
National Asthma Council (2006) ‘Asthma management handbook 2006.’ (National Asthma Council Australia Ltd: South Melbourne, VIC)
National Heart, Lung and Blood Institute (2007) ‘Expert panel report 3: guidelines for the diagnosis and management of asthma.’ (National Institutes of Health, Department of Health and Human Services: Bethesda, MD)
Powell H, Gibson PG (2003) Inhaled corticosteroid doses in asthma: an evidence-based approach. The Medical Journal of Australia 178, 223–225.
Medicare Australia (2010) ‘Practice incentives program (PIP) – asthma incentive’ (Medicare Australia: Canberra, ACT) Available at http://www.medicareaustralia.gov.au/provider/incentives/pip/payment-formula/asthma-incentive.jsp [Verified 7 Sept 2010]
Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, Weiss ST (2004) Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. The Journal of Allergy and Clinical Immunology 114, 40–47.
| Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys.Crossref | GoogleScholarGoogle Scholar |
Shah S, Roydhouse JK, Sawyer SM (2008) Asthma education in primary healthcare settings. Current Opinion in Pediatrics 20, 705–710.
| Asthma education in primary healthcare settings.Crossref | GoogleScholarGoogle Scholar |
Shah S, Toelle BG, Sawyer SM, Roydhouse JK, Edwards P, Usherwood T, Jenkins CR (2010) Feasibility study of a communication and education asthma intervention for general practitioners in Australia. Australian Journal of Primary Health 16, 75–80.
| Feasibility study of a communication and education asthma intervention for general practitioners in Australia.Crossref | GoogleScholarGoogle Scholar |
Sulaiman ND, Barton CA, Abramson MJ, Liaw T, Harris C, Chondros P, Dharmage S, Clarke D (2004) Factors associated with ownership and use of written asthma action plans in north-west Melbourne. Primary Care Respiratory Journal 13, 211–217.
| Factors associated with ownership and use of written asthma action plans in north-west Melbourne.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD283ntlCnsg%3D%3D&md5=d15e90074c1a912dca45b9a652732833CAS |
Sulaiman ND, Barton CA, Liaw ST, Harris CA, Sawyer SM, Abramson MJ, Robertson C, Dharmage SC (2010) Do small group workshops and locally adapted guidelines improve asthma patients’ health outcomes? A cluster randomized controlled trial. Family Practice 27, 246–254.
| Do small group workshops and locally adapted guidelines improve asthma patients’ health outcomes? A cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
Tsuyuki RT, Sin DD, Sharpe HM, Cowie RL, Nilsson C, Man SF (2005) Management of asthma among community-based primary care physicians. The Journal of Asthma 42, 163–167.
Williamson MK, Pirkis J, Pfaff JJ, Tyson O, Sim M, Kerse N, Lautenschlager NT, Stocks NP, Almeida OP (2007) Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. BMC Medical Research Methodology 7, 42
| Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study.Crossref | GoogleScholarGoogle Scholar |
Zwar NA, Comino EJ, Hasan I, Harris MF, Primary Health Care Research Network (2005) General practitioner views on barriers and facilitators to implementation of the asthma 3+ visit plan. The Medical Journal of Australia 183, 64–67.