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Abstract：
Little is known about specialist-specific variations in guideline agreement and adoption.
To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program\'s Third Expert Panel Report.
Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and \"almost always\" adhering to recommendations (ie, ≥75% of the time).
Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups \"almost always\" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing.
Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program\'s Third Expert Panel Report.
Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and \"almost always\" adhering to recommendations (ie, ≥75% of the time).
Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups \"almost always\" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P = .06), asked about nighttime awakening (91.9% vs 76.5%, P = .03) and emergency department visits (92.2% vs 76.5%, P = .03), assessed home triggers (70.5% vs 52.6%, P = .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing.
Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.
摘要：
对于指南协议和采用中的特定于专家的变化知之甚少。
评估变态反应学家和肺科医师在坚持国家哮喘教育和预防计划的第三专家小组报告的基石组成部分之间的异同。
自我报告的指南协议，自我效能感,在2012年全国哮喘医师调查中,对过敏症专科医生(n=134)和肺科医师(n=99)的依从性进行了评估.多变量模型用于评估医师和实践特征是否解释了专业和“几乎总是”遵守建议之间的双变量关联（即，≥75%的时间)。
过敏症专家和肺科医师报告了较高的指南自我效能感和中等的指南一致性。两组“几乎总是”评估哮喘控制(66.2%，标准误差[SE]4.3)，评估了学校/工作哮喘的诱因(71.3%，SE,3.9),并认可吸入性皮质类固醇的使用(95.5%，SE2.0）。反复评估吸入器技术，使用哮喘行动/治疗计划，肺活量测定较低(39.7%，SE4.0；30.6%，SE3.6；44.7%，分别为SE4.1)。与肺科医生相比，更多的过敏症患者几乎总是进行肺活量测定(56.6%vs38.6%，P=.06），被问及夜间觉醒(91.9%vs76.5%，P=0.03）和急诊科就诊（92.2%vs76.5%，P=.03)，评估了家庭触发因素(70.5%对52.6%，P=.06），并进行了过敏测试(61.8%vs21.3%，P<.001)。在多变量分析中，具体实践特征解释了除过敏测试外的差异。
总的来说，过敏症专家和肺科医师遵守哮喘指南，但有明显的例外，包括哮喘行动计划使用和吸入器技术评估。执行率低的建议为进一步探索提供了机会，并可作为增加准则吸收的目标。
评估变态反应学家和肺科医师在坚持国家哮喘教育和预防计划的第三专家小组报告的基石组成部分之间的异同。
自我报告的指南协议，自我效能感,在2012年全国哮喘医师调查中,对过敏症专科医生(n=134)和肺科医师(n=99)的依从性进行了评估.多变量模型用于评估医师和实践特征是否解释了专业和“几乎总是”遵守建议之间的双变量关联（即，≥75%的时间)。
过敏症专家和肺科医师报告了较高的指南自我效能感和中等的指南一致性。两组“几乎总是”评估哮喘控制(66.2%，标准误差[SE]4.3)，评估了学校/工作哮喘的诱因(71.3%，SE,3.9),并认可吸入性皮质类固醇的使用(95.5%，SE2.0）。反复评估吸入器技术，使用哮喘行动/治疗计划，肺活量测定较低(39.7%，SE4.0；30.6%，SE3.6；44.7%，分别为SE4.1)。与肺科医生相比，更多的过敏症患者几乎总是进行肺活量测定(56.6%vs38.6%，P=.06），被问及夜间觉醒(91.9%vs76.5%，P=0.03）和急诊科就诊（92.2%vs76.5%，P=.03)，评估了家庭触发因素(70.5%对52.6%，P=.06），并进行了过敏测试(61.8%vs21.3%，P<.001)。在多变量分析中，具体实践特征解释了除过敏测试外的差异。
总的来说，过敏症专家和肺科医师遵守哮喘指南，但有明显的例外，包括哮喘行动计划使用和吸入器技术评估。执行率低的建议为进一步探索提供了机会，并可作为增加准则吸收的目标。
