PDF(Pubmed)
Abstract：
UNASSIGNED: The National Asthma Education and Prevention Program guidelines emphasize environmental control as an integral part of asthma management; however, limited national-level data exist on how clinicians implement environmental control recommendations.
UNASSIGNED: We analyzed data on clinicians\' self-reported use of recommended environmental control practices in a nationally representative sample (n = 1645) of primary care physicians, asthma specialists, and advanced practice providers from the National Asthma Survey of Physicians, a supplemental questionnaire to the 2012 National Ambulatory Medical Care Survey.
UNASSIGNED: We examined clinician and practice characteristics as well as clinicians\' decisions and strategies regarding environmental trigger assessment and environmental control across provider groups. Regression modeling was used to identify clinician and practice characteristics associated with implementation of guideline recommendations.
UNASSIGNED: A higher percentage of specialists assessed asthma triggers at home, school, and/or work than primary care or advanced practice providers (almost always: 53.6% vs 29.4% and 23.7%, respectively, P < .001). Almost all clinicians (>93%) recommended avoidance of secondhand tobacco smoke, whereas recommendations regarding cooking appliances (eg, proper ventilation) were infrequent. Although assessment and recommendation practices differed between clinician groups, modeling results showed that clinicians who reported almost always assessing asthma control were 5- to 6-fold more likely to assess environmental asthma triggers. Use of asthma action plans was also strongly associated with implementation of environmental control recommendations.
UNASSIGNED: Environmental assessment and recommendations to patients varied among asthma care providers. High adherence to other key guideline components, such as assessing asthma control, was associated with environmental assessment and recommendation practices on environmental control.
UNASSIGNED: We analyzed data on clinicians\' self-reported use of recommended environmental control practices in a nationally representative sample (n = 1645) of primary care physicians, asthma specialists, and advanced practice providers from the National Asthma Survey of Physicians, a supplemental questionnaire to the 2012 National Ambulatory Medical Care Survey.
UNASSIGNED: We examined clinician and practice characteristics as well as clinicians\' decisions and strategies regarding environmental trigger assessment and environmental control across provider groups. Regression modeling was used to identify clinician and practice characteristics associated with implementation of guideline recommendations.
UNASSIGNED: A higher percentage of specialists assessed asthma triggers at home, school, and/or work than primary care or advanced practice providers (almost always: 53.6% vs 29.4% and 23.7%, respectively, P < .001). Almost all clinicians (>93%) recommended avoidance of secondhand tobacco smoke, whereas recommendations regarding cooking appliances (eg, proper ventilation) were infrequent. Although assessment and recommendation practices differed between clinician groups, modeling results showed that clinicians who reported almost always assessing asthma control were 5- to 6-fold more likely to assess environmental asthma triggers. Use of asthma action plans was also strongly associated with implementation of environmental control recommendations.
UNASSIGNED: Environmental assessment and recommendations to patients varied among asthma care providers. High adherence to other key guideline components, such as assessing asthma control, was associated with environmental assessment and recommendation practices on environmental control.
摘要：
■国家哮喘教育和预防计划指南强调环境控制是哮喘管理的一个组成部分；然而，关于临床医生如何实施环境控制建议的国家级数据有限。
■我们分析了临床医生自我报告使用推荐的环境控制实践的数据，这些数据是在具有全国代表性的初级保健医生样本（n=1645）中，哮喘专家，和来自全国哮喘医师调查的高级实践提供者，2012年全国门诊医疗调查的补充问卷。
我们检查了临床医生和实践特征以及临床医生关于环境触发因素评估和跨提供者组环境控制的决策和策略。回归模型用于确定与指南建议实施相关的临床医生和实践特征。
■在家中评估哮喘诱因的专家比例更高，学校,和/或工作比初级保健或高级实践提供者(几乎总是：53.6%vs29.4%和23.7%，分别,P<.001)。几乎所有的临床医生（>93％）建议避免二手烟，而关于烹饪用具的建议(例如，适当的通风）很少。尽管临床医师组之间的评估和推荐实践有所不同，建模结果显示,报告几乎总是评估哮喘控制的临床医师评估环境哮喘触发因素的可能性高出5~6倍.哮喘行动计划的使用也与环境控制建议的实施密切相关。
■哮喘护理提供者对患者的环境评估和建议各不相同。高度遵守其他关键指南组件，比如评估哮喘控制，与环境评估和环境控制建议实践有关。
■我们分析了临床医生自我报告使用推荐的环境控制实践的数据，这些数据是在具有全国代表性的初级保健医生样本（n=1645）中，哮喘专家，和来自全国哮喘医师调查的高级实践提供者，2012年全国门诊医疗调查的补充问卷。
我们检查了临床医生和实践特征以及临床医生关于环境触发因素评估和跨提供者组环境控制的决策和策略。回归模型用于确定与指南建议实施相关的临床医生和实践特征。
■在家中评估哮喘诱因的专家比例更高，学校,和/或工作比初级保健或高级实践提供者(几乎总是：53.6%vs29.4%和23.7%，分别,P<.001)。几乎所有的临床医生（>93％）建议避免二手烟，而关于烹饪用具的建议(例如，适当的通风）很少。尽管临床医师组之间的评估和推荐实践有所不同，建模结果显示,报告几乎总是评估哮喘控制的临床医师评估环境哮喘触发因素的可能性高出5~6倍.哮喘行动计划的使用也与环境控制建议的实施密切相关。
■哮喘护理提供者对患者的环境评估和建议各不相同。高度遵守其他关键指南组件，比如评估哮喘控制，与环境评估和环境控制建议实践有关。
