Asthma care practices, perceptions, and beliefs of Chicago-area asthma specialists

Introduction: Fem studies have closely explored how well physicians who con sider themselves specialists in asthma adhere to national guideline recomme ndations for the diagnosis and treatment of asthma. The purpose of this stu dy is to characterize current knowledge, attitudes, beliefs, and self-repor ted treatment practices of the asthma specialists working in one large metr opolitan al ea. Methods: In 1997, a cross-sectional survey was mailed to asthma specialists (allergists or pulmonologists) engaged in direct patient care with a pract ice location in the Chicago area (Cook Country or one of the five surroundi ng counties). An approximately 50% random sample of asthma specialists was surveyed. The survey included items on (1) asthma diagnosis; (2) clinical m onitoring of asthma patients; (3) pharmacologic and nonpharmacologic asthma treatment; (4) opinions and beliefs about asthma treatment options and rea sons for referrals; (5) involvement in continuing medical education; (6) ex periences with managed tare; (7) use of asthma practice guidelines; (8) dem ographic information about the respondents; and (9) characteristics of the practice settings. Results: A total of 113 eligible surveys were returned (response rate, 72.0 %). Ninety-nine percent of the respondents indicated they would prescribe i nhaled corticosteroids for patients greater than or equal to 5 years old wi th moderate persistent asthma, and 85.5% would prescribe them for patients < 5 years old. The respondents reported that 71.2% of their patients with m oderate or severe persistent asthma were routinely given written treatment plans. The use of these plans was reported more frequently by allergists th an pulmonologists (77.6% vs 58.9%, p = 0.01). Nearly half of the respondent s were involved in the development of hospital-based asthma programs; fewer (14.9%) were involved ill developing asthma programs for managed care orga nizations. A majority (63.4%) of the physicians had given a formal professi onal education presentation on asthma in the past year. A majority of the r espondents who care for patients under managed care contracts reported that these patients have encountered barriers to access in seeking specialty ca re. Conclusion: The results suggest that asthma specialists in the Chicago area are providing asthma care that is, in many ways, consistent with national guidelines. However, there are also important differences in care that ale not consistent with the guideline recommendations. Perhaps even more notabl e are differences in reported asthma care between the two subspecialty grou ps of allergists and pulmonologists. The effect of these differences on the management of persons with asthma is not known. It is hoped that informati on from this community-based sun ey will serve to catalyze discussions amon g Chicago-area asthma specialists as to how they might envision improving c are for persons with asthma in their community.