Barriers to adherence to asthma management guidelines among inner-city primary care providers

Ann Allergy Asthma Immunol. 2008 Sep;101(3):264-70. doi: 10.1016/S1081-1206(10)60491-7.


Background: Health care provider adherence to national asthma guidelines is critical in translating evidence-based recommendations into improved outcomes. Unfortunately, provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) guidelines remains low.

Objective: To identify barriers to guideline adherence among primary care professionals providing care to inner-city, minority patients with asthma.

Methods: We surveyed 202 providers from 4 major general medicine practices in East Harlem in New York, New York. The study outcome was self-reported adherence to 5 NHLBI guideline components: inhaled corticosteroid (ICS) use, peak flow (PF) monitoring, action plan use, allergy testing, and influenza vaccination. Potential barriers included lack of agreement with guideline, lack of self-efficacy, lack of outcome expectancy, and external barriers.

Results: Most providers reported adhering to the NHLBI guidelines for ICS use (62%) and for influenza vaccinations (73%). Self-reported adherence was 34% for PF monitoring, 9% for asthma action plan use, and 10% for allergy testing. Multivariate analyses showed that self-efficacy was associated with increased adherence to ICS use (odds ratio [OR], 2.8; P = .03), PF monitoring (OR, 2.3; P = .05), action plan use (OR, 4.9; P = .03), and influenza vaccinations (OR, 3.5; P = .05). Conversely, greater expected patient adherence was associated with increased adherence to PF monitoring (OR, 3.3; P = .03) and influenza vaccination (OR, 3.5; P = .01). Familiarity with specific guideline components and higher level of training were also predictors of adherence.

Conclusions: Lack of outcome expectancy and poor provider self-efficacy prevent providers from adhering to national asthma guidelines. Efforts to improve provider adherence should address these specific barriers.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Asthma / therapy*
  • Attitude of Health Personnel
  • Disease Management
  • Guideline Adherence / statistics & numerical data*
  • Health Care Surveys
  • Health Personnel*
  • Humans
  • Minority Groups
  • Multivariate Analysis
  • New York City
  • Odds Ratio
  • Patient Compliance
  • Practice Guidelines as Topic*
  • Primary Health Care*
  • Urban Health Services*