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Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Primary-Care Physicians^*

Evalyn N. Grant, MD; James N. Moy, MD; Karen Turner-Roan, MPH; Steven R. Daugherty, PhD; Kevin B. Weiss, MD and for the Chicago Asthma Surveillance Initiative Project Team

^* From the Department of Immunology/Microbiology (Dr. Grant), the Center for Health Services Research, Rush Primary Care Institute (Ms. Turner-Roan, Drs. Daugherty, and Weiss), Rush-Presbyterian-St. Luke's Medical Center, and the Department of Pediatrics, Cook County Children's Hospital (Dr. Moy), Chicago, IL. See Appendix for other members of the CASI Project Team.

Correspondence to: Kevin B. Weiss, MD, Center for Health Services Research, Rush Primary Care Institute, Rush-Presbyterian-St. Luke's Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612

Introduction: Although primary-care physicians were a principal target audience for the National Asthma Education and Prevention Program (NAEPP), there is little published information describing the postguideline asthma care practices of these physicians or their willingness to embrace the NAEPP guidelines. This study examines asthma care practices of Chicago-area primary-care physicians and assesses these practitioners' perceptions and beliefs about several aspects of the NAEPP guidelines.

Methods: In 1997, a self-administered survey was mailed to a randomly selected 10% sample of Chicago-area general pediatricians, internists, and family practitioners.

Results: Surveys were returned by 244 of the 405 eligible Chicago-area primary-care physicians (60.2%) in the sample. Of these, 66 (27.6%) were pediatricians, 83 (34.7%) were general internists, and 90 (37.7%) were family practitioners. Physicians reported that 54.6 ± 2.7% (mean ± SE) of patients with newly diagnosed asthma have spirometry performed as part of their initial evaluation. For patients with moderate persistent asthma,prescribing of inhaled corticosteroids varied by patient age, with 60.5% of physicians routinely prescribing them for patients < 5 years, compared with 95.7% of physicians prescribing them for patients 5 years. Awareness of the NAEPP guide-lines among these physicians was high, with 88.5% reporting that they have heard of the guidelines, and 73.6% reporting having read them. Of patients with moderate or severe persistent asthma, physicians estimated that 47.7 ± 2.7% were given written treatment plans.

Conclusion: Several aspects of the NAEPP guidelines appear to have been incorporated into clinical practice by Chicago-area primary-care physicians, whereas other recommendations do not appear to have been readily adopted. This information suggests areas for interventions to improve primary care for asthma in the Chicago area.

(CHEST 1999; 116:145S–154S

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