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Pediatricians Fail to Use Recommended Test for Asthma in Children

http://www.medscape.com/viewarticle/728126

Pediatricians Fail to Use Recommended Test for Asthma in Children

September 7, 2010 — The use of spirometry testing to diagnose and manage asthma

in children is underused by pediatric primary care physicians, especially

pediatricians, and does not conform to national guidelines.

Moreover, getting these physicians to implement national asthma guidelines would

likely require a major educational initiative to address deficiencies in

spirometry interpretation and other barriers.

The findings, from a survey of 360 physicians who provide care to children with

asthma, are published online in the September 6 issue of Pediatrics. " The

National Asthma Education and Prevention Program (NAEPP) Expert Panel Report

guidelines underscore the importance of spirometry in the initial diagnosis of

asthma and at least once per year thereafter for ongoing management, " write

J. Dombkowski, DrPH, MS, from the University of Michigan, Ann Arbor, and

colleagues. " Previous studies suggested that physicians often underestimate

asthma severity in the absence of spirometric results and the course of

treatment may be altered substantially when spirometric information is made

available. "

In the present study, the authors sought to explore the use of spirometry in

primary care settings. They mailed surveys to office-based general pediatricians

and family physicians to ascertain their use of spirometry and peak flow meters,

their attitudes toward lung function testing, and things that might prevent them

from using spirometry in their practice.

The survey included a clinical vignette that was used to assess how spirometry

would affect a physician's recognition of asthma severity and subsequent

medication choices.

The study found that 52% of the physicians surveyed used spirometry, 80% used

peak flow meters, and 10% used no lung function tests. Only 21% reported the

routine use of spirometry for all guideline-recommended clinical situations.

The use of spirometry was more common among family physicians than among

pediatricians (75% vs 35%; P < .0001), and family physicians were more

comfortable than pediatricians in interpreting spirometric results (50% vs 25%;

P < .0001).

The study also found that 49% of the surveyed physicians correctly interpreted

the spirometric results from the clinical vignette as a moderate obstruction and

14% confessed that they did not know how to interpret the results.

Two-thirds of the physicians indicated they would want additional training on

how to use spirometry in their clinical practice. This view was more common

among pediatricians than family physicians (78% vs 53%; P < .0001). The

preferred method of spirometry training was workshops with asthma specialists

(43%), followed by continuing medical education (32%), Internet-based training

(24%), and learning from colleagues (14%).

The finding that primary care physicians lack comfort and ability interpreting

spirometric results suggests that additional training is needed so that the

benefits of spirometric testing can be fully realized. Several training programs

exist but need to be promoted more extensively among these physicians, the study

authors note.

The low response rate to the survey — just 50% — is 1 limitation of the study

and indicates that the results may not be representative of pediatric primary

care physicians as a whole. In addition, the study authors note that they did

not assess the sites where spirometry was performed, the specific equipment

used, which staff members performed the test, how staff members were trained to

do spirometry, and whether the tests were performed according to criteria

established by the American Thoracic Society.

They conclude, " Training programs should be especially important for pediatric

physicians and their staff members, not only to promote widespread use of

spirometry but also to ensure correct interpretation of results. Widespread

implementation of the NAEPP guidelines for spirometry likely would require a

major initiative to address common barriers experienced by pediatric primary

care providers. "

They add that future studies should be done to determine the effectiveness of

different types of spirometry training in pediatric primary care settings.

This study was supported by the Blue Cross Blue Shield of Michigan Foundation.

The study authors have disclosed no relevant financial relationships.

Pediatrics. 2010;126:682-687.

Medscape Medical News © 2010 WebMD, LLC

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