Effect of local standards on the implementation of national guidelines for @entity565 : primary care agreement with national XXXX guidelines.

@entity1 @entity565 @entity230
OBJECTIVE: To assess the level of modification by local primary care doctors of key aspects of the National Asthma Education Program (NAEP) Guidelines for the Diagnosis and Management of Asthma. DESIGN: A random sample of primary care physicians participating in @entity565 guideline development. SETTING: Two hospital systems, one based in an urban environment, and a second in a community and rural environment. @entity1 : Primary care physicians. INTERVENTION: Design of consensus-based @entity565 guidelines using a modified Delphi approach. MEASUREMENTS AND MAIN RESULTS: A total of 42 physicians participated in the local guideline development. With few exceptions, the primary care physicians modified in major ways the NAEP Guidelines regarding the role of pulmonary function testing and spirometry. Specifically, the local guidelines did not require peak flow and spirometry measurements as the basis for initiating inhaled @entity230 as did the national guidelines. All 42 physicians emphasized a clinical diagnosis versus one based on a pulmonary function. Peak flow monitoring was recommended by 35 (83%) of physicians in selected @entity1 only, in contrast to the national guidelines, which emphasized monitoring for all @entity1 routinely and during exacerbations. There was strong agreement with the national guidelines on the role and importance of @entity1 education, and on the indications for the use of inhaled @entity230 . CONCLUSIONS: Disagreement by primary care doctors with parts of the NAEP guideline is a potential cause for poor compliance and lack of influence on @entity1 care. Recognizing the need to modify or customize guidelines through field testing with local primary care physicians will improve acceptance of national guidelines.
