A survey of asthma management, the physicians' perspective

grantor: University of Toronto"Asthma management" refers to the formulation and execution of treatment decisions and patient education strategies within the context of the physician-patient relationship. However, little is known about the physician's perspective on these elements of asthma management. This gap in knowledge is important, given the lack of unanimity regarding the optimal approach to asthma management, and the reported increases in asthma morbidity and mortality rates. The purpose of this study was threefold: (i) to examine treatment and education strategies of physicians who manage adult asthma patients; (ii) to determine if strategy differences exist between family physicians and specialists; and (iii) to examine the consistency between physicians' treatment recommendations and those advocated by existing guidelines. Using a mailed survey, data were collected from 163 randomly selected Ontario family physicians (n = 80; 78% response rate) and specialists (n = 83; 83% response rate) representing an overall response rate of 80%. The questionnaire sought self reports about treatment recommendations for 6 hypothetical asthma profiles, the provision of 9 asthma patient education activities, and patient involvement in management decisions. The profiles revealed particular areas of physician uncertainty regarding asthma treatment, for the group as a whole as well as within each physician subgroup. The education provision scores varied according to the level of disease severity (F = 205; p $<$ 0.01), and the specialists (70 $\pm$ 6.4) obtained higher mean scores for overall education provision than family physicians (66 $\pm$ 8.4; t = 2.9, p $<$ 0.01). The physicians indicated that they perceive that patients are less involved in managing asthma than they would prefer (z = 6.0, p $<$ 0.01). For the full study group, the mean overall scan far consistency with guidelines was 4.6 $\pm$ 1.2 (theoretical total score: 6), and the subgroup mean scores differed significantly (family physicians: 4.2 $\pm$ 1.2; specialists 5.1 $\pm$ 0.9; t = 5.46, p $<$ 0.01). These results imply that the provision of patient education and the consistency of treatment recommendations with published guidelines may interact with the disease severity and the physician's professional background. The descriptive patterns identified here form a comparison database for future comparative investigations of the patients' perspective regarding these elements of asthma management.Ph.D