Compliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational study

doi:10.1016/j.rceng.2019.11.006

Revista Clínica Española (English Edition)

Volume 221, Issue 4, April 2021, Pages 207-216

https://doi.org/10.1016/j.rceng.2019.11.006 Get rights and content

Abstract

Objective

To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease.

Material and methods

We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated.

Results

Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06).

Conclusions

Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with a better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.

Resumen

Objetivo

Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad.

Material y métodos

Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2864 pacientes.

Resultados

Utilizando datos retrospectivos, 81 de los 314 médicos (25,8% [IC del 95%, 21,3 a 30,9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28,0% [IC del 95%, 23,4 a 33,2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0,19, IC del 95%, 0,13 a 0,28) y presentar un asma persistente grave al inicio del estudio (OR 0,20, IC del 95%, 0,12 a 0,34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1,70, IC del 95%, 1,40 a 2,06).

Conclusiones

El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma.

Section snippets

Background

Clinical practice guidelines (CPGs) offer the possibility of reducing the inappropriate variability of clinical practice, improving the incorporation of scientific evidence into clinical practice and improving the quality and safety of healthcare.¹

Compliance with asthma guidelines has been associated with better control of the disease's symptoms and reduced drug expenses.² In contrast, poor compliance has been associated with an increased number of exacerbations and hospitalizations.³ Most

Patients and methods

This observational study included a retrospective phase to assess the prior degree of compliance with the GEMA 2009 recommendations, as well as a prospective phase in which compliance with the GEMA 2015 recommendations and its repercussion on asthma control were assessed. The study was approved by the Clinical Research Ethics Committee of the Balearic Islands (Palma de Mallorca, Spain) and obtained written informed consent from all patients before including them in the study.

Patient distribution and clinical and demographic characteristics

We conducted the study between September 2015 and April 2016; 314 primary care physicians participated in the study and recruited 2864 patients. We excluded 40 patients (1.4%) from the analysis, mainly because they had incomplete data in the retrospective visit (n = 25) or the initial visit (n = 31).

Table 1 shows the characteristics of the participating physicians. More than 95% of the physicians were aware of and followed the GEMA recommendations. Although 75% of the physicians responded that they

Discussion

Our study showed low compliance by primary care physicians with the GEMA in Spain and that following the guidelines is associated with a better asthma control. A minimal approach such as providing a brief summary in writing of the developments included in the 2015 version of GEMA was associated with a slight increase in compliance with these guidelines.

In our study, overall compliance with the most current version of GEMA 2015 was 28%, a finding is consistent with the results of a previous

Conclusion

A lack of compliance with asthma CPGs (GEMA) is a common problem among health professionals who treat this disease, and this study confirmed the results of previous studies that have shown that this problem is more common among primary care physicians.10, 12, 22 In general, action is needed to improve compliance among primary care physicians with the recommendations of asthma guidelines.

Funding

This study was funded by Mundipharma Pharmaceuticals S.L. (Madrid, Spain). The sponsor participated jointly with the authors in designing and drafting the article and in the decision to send the article for publication.

Conflicts of interest

MR has received honoraria as a speaker and consultant from AZ, BI, Chiesi, GSK, Menarini, Mundipharma, Novartis, Pfizer, Rovi and Teva, as well as research subsidies to the author's institution from GSK.

JM has received honoraria as a speaker from Astra-Zeneca, Boehringer Ingelheim, GSK, Menarini and Novartis, as well as honoraria as a speaker from Astra-Zeneca and GSK.

AF is a full-time employee of Mundipharma Pharmaceuticals S.L.

Acknowledgements

The authors would like to thank Laura Casas (Dynamic Solutions, Madrid, Spain) for her assistance in performing the statistical analysis and Fernando Rico-Villademoros (COCIENTE S.L., Madrid, Spain) for preparing the draft manuscript. Their participation was funded by Mundipharma Pharmaceuticals S.L.

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^☆: Please cite this article as: Roman-Rodriguez M, Molina-Paris J, Fernandez-Sanchez A, en nombre del grupo de investigación GAP-asma. Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo. Rev Clin Esp. 2021;221:207–216.

^◊: The other members of the GAP-asthma workgroup are listed in Appendix 1.

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Original articleCompliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational studySeguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo☆