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Specialty Differences in Prescribing Inhaled Corticosteroids for Children

Department of Pediatrics, University of California, San Francisco, California, Department of Epidemiology and Biostatistics, University of California, San Francisco, California, Institute for Health Policy Studies, University of California, San Francisco, Califorinia, michael.cabana{at}ucsf.edu

Heba Abu-Isa

University of Michigan School of Medicine, Ann Arbor, Michigan

Shannon M. Thyne, MD

Department of Pediatrics, University of California, San Francisco, California

Barbara Yawn, MD, MsPH, MSc

Department of Research, Olmsted Medical Center, Rochester, Minnesota

Prescription of daily inhaled corticosteroids for children with persistent asthma is infrequent compared with national practice guidelines. The authors conducted a national, cross-sectional survey of pediatricians and family physicians to identify specialty differences and factors associated with physician nonadherence to National Heart, Lung, and Blood Institute guidelines for prescribing inhaled corticosteroids. Adherence was defined as following the recommendation for >90% of cases. Response rate was 49% (343/694). Pediatrician and family physicians reported similar rates of adherence (54% vs 51%). Pediatricians and family physicians reported different barriers. Although both groups indicated that parent hesitancy and nonadherence were common barriers, the most common barrier for family physicians was a perceived cost of the asthma medications for families. Pediatricians were more likely to indicate that lack of time (21% vs 10%) was a barrier to prescribing inhaled corticosteroids. In multivariate logistic analysis, the lack of a family/practice barrier (odds ratio, 0.27; 95% confidence interval, 0.13, 0.55) and physician agreement with the National Heart, Lung, and Blood Institute recommendation (odds ratio, 4.21; 95% confidence interval, 1.43, 12.3) was associated with self-reported adherence. Interventions to improve prescribing of inhaled corticosteroids should include strategies to address issues specific to pediatricians and family physicians.

Key Words: physician training • practice management • quality improvement

This version was published on October 1, 2007

Clinical Pediatrics, Vol. 46, No. 8, 698-705 (2007)
DOI: 10.1177/0009922807301436


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