Table V.
Clinician-Reported Agreement and Self-efficacy with EPR-3 Asthma Guidelines
| Primary Care Clinicians | Asthma Specialists | |||
|---|---|---|---|---|
| Panel A: Agreement, weighted % (SE) | n | Strongly agree | Strongly agree | P Valuea |
| Spirometry is essential for diagnosis | 1638 | 35.5 (2.3) | 77.6 (3.8) | <.001 |
| ICS are effective for persistent asthma | 1633 | 48.3 (2.3) | 76.0 (3.4) | <.001 |
| Asthma Action Plans are effective | 1639 | 30.6 (2.1) | 41.0 (4.1) | .0258 |
| Follow up visits for persistent asthma every 6 months | 1639 | 48.9 (2.3) | 68.8 (3.5) | <.001 |
| Assessing severity is necessary for initial therapy | 1632 | 50.3 (2.4) | 79.3 (3.3) | <.001 |
| Overall agreement index | 1642 | 12.1 (1.4) | 27.9 (3.9) | <.001 |
| Panel B: Asthma Self - efficacy, weighted % (SE) | n | Very confident | Very confident | |
| Confidence using spirometry | 1636 | 37.0 (2.3) | 92.8 (2.1) | <.001 |
| Confidence assessing severity | 1635 | 49.4 (2.4) | 81.3 (3.5) | <.001 |
| Confidence prescribing ICS | 1642 | 65.2 (2.2) | 91.1 (2.2) | <.001 |
| Confidence step ping up therapy | 1641 | 64.5 (2.3) | 89.5 (2.4) | <.001 |
| Confidence step ping down therapy | 1639 | 49.8 (2.4) | 87.0 (2.6) | <.001 |
| Overall self - efficacy index | 1642 | 21.5 (2.1) | 72.3 (3.9) | <.001 |
| Primary Care Clinicians | Asthma Specialists | |||||
|---|---|---|---|---|---|---|
| Panel C: Association between adherence and strong agreement and high self-efficacy, OR (95% CI)b | n | Strong agreement (vs other) | High self-efficacy (vs. other) | n | Strong agreement (vs. other) | High self-efficacy (vs other) |
| Provide Asthma Action Plan | 1391 | 2.0 (1.1, 3.6)* | 2.4 (1.3, 4.3)* | 233 | 1.6 (0.7, 3.3) | 1.1 (0.5, 2.5) |
| Document asthma control | 1321 | 1.4 (0.8, 2.5) | 1.8 (1.0, 3.0)* | 226 | 0.8 (0.3, 2.1) | 1.5 (0.6, 3.5) |
| Ask about ability to engage in normal activities | 1392 | 1.7 (0.9, 3.2) | 2.1 (1.2, 3.5)* | 232 | 1.3 (0.4, 4.4) | 1.5 (0.6, 4.3) |
| Ask about frequency of daytime symptoms | 1398 | 1.5 (0.8, 2.9) | 2.3 (1.3, 4.1)* | 233 | 1.6 (0.4, 7.5) | 3.9 (1.0, 16.0) |
| Ask about frequency of nighttime awakenings | 1396 | 1.4 (0.8, 2.5) | 1.7 (1.0, 2.9) | 233 | 0.7 (0.2, 2.0) | 2.7 (0.9, 7.8) |
| Ask about patient perception of control | 1395 | 0.9 (0.5, 1.5) | 1.9 (1.1, 3.3)* | 233 | 1.6 (0.6, 4.3) | 1.2 (0.4, 3.0) |
| Use a control assessment tool | 1395 | 1.5 (0.8, 2.9) | 1.7 (0.9, 3.0) | 233 | 1.0 (0.5, 2.1) | 1.3 (0.6, 2.9) |
| Ask about frequency of rescue inhaler use | 1398 | 2.9 (1.6, 5.5)* | 2.7 (1.5, 4.7)* | 233 | 0.4 (0.1, 2.2) | 3.0 (0.6, 14.4) |
| Ask about ED visit frequency | 1398 | 1.3 (0.7, 2.3) | 3.0 (1.8, 4.8)* | 232 | 0.8 (0.3, 2.8) | 2.9 (1.0, 8.4) |
| Ask about oral steroid frequency | 1396 | 1.1 (0.6, 2.1) | 4.3 (2.6, 7.1)* | 232 | 0.7 (0.2, 2.8) | 1.4 (0.4, 5.1) |
| Ask about home peak flow results | 1396 | 2.0 (1.0, 4.0) | 3.1 (1.6, 6.1)* | 231 | 1.8 (0.7, 5.0) | 2.4 (0.8, 7.6) |
| Perform spirometry | 1378 | 2.1 (0.9, 4.7) | 6.3 (3.0, 13.4)* | 232 | 1.1 (0.5, 2.2) | 4.3 (2.0, 9.0)* |
| Assess daily controller use for persistent asthma | 1392 | 1.9 (1.1, 3.2)* | 2.4 (1.4, 4.4)* | 232 | 0.7 (0.2, 2.7) | 2.0 (0.6, 6.6) |
| Repeated assessment of inhaler technique | 1393 | 1.5 (0.7, 2.9) | 2.8 (1.6, 5.0)* | 233 | 1.5 (0.8, 3.1) | 0.8 (0.4, 1.9) |
| Assess home triggers | 1394 | 1.5 (0.9, 2.5) | 3.3 (1.9, 5.5)* | 233 | 0.8 (0.4, 1.7) | 1.9 (0.9, 4.2) |
| Assess school or workplace triggers | 1408 | 1.4 (0.8, 2.4) | 4.1 (2.5, 6.9)* | 233 | 0.8 (0.3, 1.7) | 1.5 (0.7, 3.6) |
| Test for allergic sensitivity | 1383 | 1.3 (0.5, 3.7) | 6.0 (2.5, 14.4)* | 233 | 1.1 (0.5, 2.4) | 1.8 (0.9, 3.8) |
*
P<.05.
a
Chi-square test for difference between primary care clinicians and asthma specialists.
b
Logistic regression models stratified by primary care clinicians and asthma specialists. Independent variables included agreement index (strong agreement versus all other responses) and self-efficacy index (high self-efficacy versus all other responses). See Supplemental Table e4 for logistic regression models with additional covariates.
CI: confidence interval; ED: emergency department; EPR-3: Expert Panel Report 3; ICS: inhaled corticosteroids; SE: standard error
Data Source: NCHS, National Asthma Survey of Physicians, 2012