EFFECT OF LOCAL STANDARDS ON THE IMPLEMENTATION OF NATIONAL GUIDELINES FOR ASTHMA - PRIMARY-CARE AGREEMENT WITH NATIONAL-ASTHMA-GUIDELINES

OBJECTIVE: To assess the level of modification by local primary care d octors of key aspects of the National Asthma Education Program (NAEP) Guidelines for the Diagnosis and Management of Asthma. DESIGN: A rando m sample of primary care physicians participating in local asthma guid eline development. SETTING: Two hospital systems, one based in an urba n environment, and a second in a community and rural environment. PART ICIPANTS: Primary care physicians. INTERVENTION: Design of consensus-b ased local asthma guidelines using a modified Delphi approach. MEASURE MENTS AND MAIN RESULTS: A total of 42 physicians participated in the l ocal guideline development. With few exceptions, the primary care phys icians modified in major ways the NAEP Guidelines regarding the role o f pulmonary function testing and spirometry. Specifically, the local g uidelines did not require peak now and spirometry measurements as the basis for initiating inhaled steroids as did the national guidelines. All 42 physicians emphasized a clinical diagnosis versus one based on a pulmonary function. Peak flow monitoring was recommended by 35 (83%) of physicians in selected patients only. in contrast to the national guidelines, which emphasized monitoring for all patients routinely and during exacerbations. There was strong agreement with the national gu idelines on the role and importance of patient education, and on the i ndications for the use of inhaled steroids. CONCLUSIONS: Disagreement by primary care doctors with parts of the NAEP guideline is a potentia l cause for poor compliance and lack of influence on patient care. Rec ognizing the need to modify or customize guidelines through field test ing with local primary care physicians will improve acceptance of nati onal guidelines.