1 Department of Pediatrics, University of Montreal, Montreal, QC, Canada H3T 1C5; Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada H3C 3J7.
2 Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5.
3 Department of Pharmacology, University of Montreal, Montreal, QC, Canada H3T 1J4.
4 Department of Family Medicine, McGill University, Montreal, QC, Canada H3T 1E2.
5 Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5; Department of Psychology, Université du Québec à Montreal, Montreal, QC, Canada H3C 3P8.
6 Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5; Department of Exercise Science, Concordia University, Montreal, QC, Canada H4B 1R6.
7 Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5.
8 Divisions of Clinical Epidemiology and of Pulmonary Medicine, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada H3T 1E2; Department of Medicine, McGill University, Montreal, QC, Canada H4A 3J1.

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma.

Can Respir J. 2016;2016:4169010

Authors: Ducharme FM, Lamontagne AJ, Blais L, Grad R, Lavoie KL, Bacon SL, McKinney ML, Desplats E, Ernst P

Abstract

Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by =60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation.

PMID: 27445537 [PubMed - indexed for MEDLINE]