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Michelle M. Cloutier, MD; Dorothy B. Wakefield, MS; Penelope S. Carlisle, MSN; Howard L. Bailit, DMD, PhD; Charles B. Hall, PhD

Arch Pediatr Adolesc Med. 2002;156:1045-1051.

Objective  To determine whether Easy Breathing, an asthma management program, improves adherence to national asthma guidelines.

Design  Before and after intervention trial.

Setting  Six urban primary care clinics in Hartford, Conn.

Participants  Thirty-four primary care physicians, 37 midlevel practitioners, 32 nurses, and 69 pediatric and family practice residents and medical students.

Interventions  Knowledge was assessed before (pretest) and after (posttest) a training program and 12 to 18 months after (follow-up) implementing Easy Breathing. Questions were divided into factual, guideline recommendation, and guideline application.

Main Outcome Measures  The percentage of correct responses on the pretest, posttest, and follow-up tests; clinician adherence to national guidelines; and clinician attitudes.

Results  The percentage of correct responses on the pretest was higher for physicians (mean, 61%; 95% confidence interval [CI], 57%-65%) than for midlevel practitioners (mean, 54%; 95% CI, 50%-59%) (P= .01). Correct responses increased significantly on the posttest for physicians (mean, 77%; 95% CI, 74%-81%) in all 3 subgroups of questions (P<.001) and for midlevel practitioners (mean, 69%; 95% CI, 63%-75%) overall and for factual and guideline questions. On the follow-up test, improvements in factual and guideline responses disappeared for all clinicians but were sustained for applied questions (mean, 78% [95% CI, 63%-94%] for physicians and 65% [95% CI, 51%-78%] for midlevel practitioners). Adherence to prescribing guidelines after implementing Easy Breathing was 93% to 99% and was associated with a 3-fold increase in inhaled corticosteroid prescriptions. Physicians reported that they had integrated Easy Breathing into practice but did not think this represented a substantial change.

Conclusions  Easy Breathing increases clinicians' knowledge and use of national guidelines. Primary care physicians believe they are adhering to guidelines even when they are not.

From the Pulmonary Division, Department of Pediatrics (Dr Cloutier and Ms Carlisle), Department of Community Medicine and Health Care (Ms Wakefield), Health Policy Center (Dr Bailit), University of Connecticut Health Center (Drs Cloutier and Bailit, and Mss Wakefield and Carlisle), Connecticut Children's Medical Center (Dr Cloutier), Hartford; and Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (Dr Hall).

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