소아천식 가이드라인의 적용에 의한 1차 진료 소아과 전문의의 진료행위의 변화와 연관된 장애요인의 분석
Implementation barriers for asthma practice guidelines in Korea : qualitative study
소아천식 가이드라인 1차 진료 소아과 전문의;
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Background: Guidelines evolve over time and their recommendations should be supported by evidence from clinical trials. In 2003 the Korean Academy of Pediatric Allergy and Respiratory Disease published 2003 Asthma Practice Guideline for children. Guidelines are being used as educational tools, quality assurance guides, standards of care, and in medical liability cases. Limited data suggest that adoption of certain rigorously tested guidelines can improve health processes and outcomes, including shorter hospital length of stays and reduced costs and utilization of resources. Unfortunately, the clinical utility of most guidelines has not been convincingly demonstrated, putting health care providers in difficult positions each time a new guideline is released and advocated. Also, the capacity of guidelines to change physician's behavior or patient outcomes is limited. Little is known about the process and factors responsible for how physicians change their practice methods when they become aware of guidelines. Objective: To review barriers to the successful use of the 2003 Asthma Practice Guideline for children and to identify strategies to improve adherence. Methods and participants: Thirty in depth semi-structured interviews were conducted with primary care pediatricians participated in Korea University allergy intensive workshop. The interviews were fully transcribed and analyzed qualitatively. Results: The role of the guideline to change pediatricians habitual practice is limited. Several barriers to the implementation of asthma practice guidelines in the management of asthma in children were identified. Type of recommendation were related to which barrier was prominent. For corticosteroid prescription, prominent barriers were lack of agreement and outcome expectancy. For patient education, lack of outcome expectancy, lack of agreement were prominent barriers. For daily peak flow meter use participants describe lack of outcome expectancy and lack of agreement. For allergen exposure counseling lack of outcome expectancy was prominent barrier. Conclusions: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, self-efficacy, lack of outcome expectancy, and inertia of previous practice that prevent adherence. Because type of recommendation are related to which barriers are prominent, interventions to improve 2003 Asthma Practice guidelines for children adherence should be tailored to these barriers.