Compliance with US asthma management guidelines and specialty care: a regional variation or national concern?

The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eigh t health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross-sectional sur vey in a managed care environment. The participants were 6703 respondents ( ages 14-65) with moderate or severe asthma. The main outcome measures were compliance with the NAEP guidelines on the use of inhaled steroids, inhaled beta(2)-agonists, peak flow measurement, and allergy evaluations. Among th e results of this survey we found that although these health plans are loca ted from the West Coast to the East Coast and the socioeconomic status of t heir members varied greatly, compliance with the NAEP guidelines was low am ong asthmatic members across all;geographical regions. The major areas of l ow. compliance identified were inappropriate pharmacological therapy, lack of objective measurement of lung function through peak now meter, and insuf ficient environmental trigger control. The regression analyses indicated th at the effect of the health plan explained little of the variation in compl iance across these regions (only 0.3% at maximum). Low compliance was assoc iated with young age, smoking, moderate asthma, being asthmatic for a few y ears, currently working, and being treated by a generalist rather than a sp ecialist. In conclusion this study showed that the compliance with the nati onal guidelines for asthma care was consistently low across different geogr aphical regions in the nation. Improvement in care for asthmatics will requ ire greater commitment and involvement by all stakeholders including physic ians, patients, health plans, and employers. We suggest a need for a nation al strategy to disseminate clinical guidelines not only to the medical comm unity but also to patients themselves.