Asia Pac Allergy.  2012 Jan;2(1):26-34. 10.5415/apallergy.2012.2.1.26.

Educational and decision-support tools for asthma-management guideline implementation

• Kim SH
• Cho SH

• KMID: 2397408
• DOI: http://doi.org/10.5415/apallergy.2012.2.1.26

Abstract

Many international and national asthma guidelines are now available in large parts of the world, but they are not yet implemented appropriately. There is a gap between scientific evidence-based medicine and real clinical practice. Implementation of guidelines is highly complex. Special strategies are needed to encourage guideline-based, high-quality care. It is important to understand the contents, the format, and the learning strategies which physicians prefer for the dissemination of guidelines. Physicians prefer more concise and immediately available guidelines that are practical to use. Thus, asthma guidelines should be disseminated as convenient and easily accessible tools. Various education programs and decision-support tools have been designed and applied to the clinical management of asthma to solve these challenging problems. Many of them have been shown to be effective at increasing physicians' knowledge and adherence to asthma guidelines and improving patients' clinical outcomes. These educational and decision-support tools are expected to contribute to a narrowing of the gap between asthma guidelines and practice/implementation of the guidelines.

Keyword

Asthma; Guideline; Education; Decision-support; Implementation

MeSH Terms

Asthma
Education
Evidence-Based Medicine
Learning

Figure

• 

  Fig. 1 Screens of Virtual Learning Center for Asthma Management program, (A) the main intro screen; (B) cyber-clinic simulations with virtual patients.

Reference

1. Braman SS. The global burden of asthma. Chest. 2006; 130:4S–12S. PMID: 16840363.

2. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004; 59:469–478. PMID: 15080825.

3. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, Weiss ST. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004; 114:40–47. PMID: 15241342.

4. Jackson R, Feder G. Guidelines for clinical guidelines. BMJ. 1998; 317:427–428. PMID: 9703522.

5. Myers TR. Guidelines for asthma management: a review and comparison of 5 current guidelines. Respir Care. 2008; 53:751–767. PMID: 18501029.

6. Fuhlbrigge AL, Adams RJ, Guilbert TW, Grant E, Lozano P, Janson SL, Martinez F, Weiss KB, Weiss ST. The burden of asthma in the United States: level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines. Am J Respir Crit Care Med. 2002; 166:1044–1049. PMID: 12379546.

7. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J. 2000; 16:802–807. PMID: 11153575.

8. Vermeire PA, Rabe KF, Soriano JB, Maier WC. Asthma control and differences in management practices across seven European countries. Respir Med. 2002; 96:142–149. PMID: 11905548.

9. Zainudin BM, Lai CK, Soriano JB, Jia-Horng W, De Guia TS. Asthma control in adults in Asia-Pacific. Respirology. 2005; 10:579–586. PMID: 16268910.

10. Tan WC, Aït-Khaled N. Dissemination and implementation of guidelines for the treatment of asthma. Int J Tuberc Lung Dis. 2006; 10:710–716. PMID: 16848330.

11. Woolcock A, Rubinfeld AR, Seale JP, Landau LL, Antic R, Mitchell C, Rea HH, Zimmerman P. Thoracic society of Australia and New Zealand. Asthma management plan, 1989. Med J Aust. 1989; 151:650–653. PMID: 2593911.

12. Hargreave FE, Dolovich J, Newhouse MT. The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol. 1990; 85:1098–1111. PMID: 2355155.

13. Guidelines for management of asthma in adults: I--Chronic persistent asthma. Statement by the British Thoracic Society, Research Unit of the Royal College of Physicians of London, King's Fund Centre, National Asthma Campaign. BMJ. 1990; 301:651–653. PMID: 1977482.

14. Expert panel report 1: Guidelines for the diagnosis and management of asthma. 1991. Bethesda: National Institutes of Health, National Asthma Education and Prevention Program.

15. Lung and Blood Institute: National Institute of Health. Global Strategy for Asthma Management and Prevention. WHO/NHLBI workshop report. 1995.

16. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Revised 2006. Available from: http://www.seicap.es/documentos/archivos/GINA2006general.pdf.

17. Lalloo UG, Walters RD, Adachi M, de Guia T, Emelyanov A, Fritscher CC, Hong J, Jimenez C, King GG, Lin J, Loaiza A, Nadeau G, Neffen H, Sekerel BE, Yorgancıoğlu A, Zar HJ. Asthma programmes in diverse regions of the world: challenges, successes and lessons learnt. Int J Tuberc Lung Dis. 2011; 15:1574–1587. PMID: 21888756.

18. Kim YY. Past, present, and future of allergy in Korea. Allergy Asthma Immunol Res. 2010; 2:155–164. PMID: 20592913.

19. Boulet LP, Borduas F, Bouchard J, Blais J, Hargreave FE, Rouleau M. Playing cards on asthma management: a new interactive method for knowledge transfer to primary care physicians. Can Respir J. 2007; 14:480–484. PMID: 18060093.

20. Le TT, Rait MA, Jarlsberg LG, Eid NS, Cabana MD. A randomized controlled trial to evaluate the effectiveness of a distance asthma learning program for pediatricians. J Asthma. 2010; 47:245–250. PMID: 20394510.

21. Freeman AC, Sweeney K. Why general practitioners do not implement evidence: qualitative study. BMJ. 2001; 323:1100–1102. PMID: 11701576.

22. Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, Pedersen SE. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med. 2004; 170:836–844. PMID: 15256389.

23. Bateman ED, Bousquet J, Busse WW, Clark TJ, Gul N, Gibbs M, Pedersen S. Stability of asthma control with regular treatment: an analysis of the Gaining Optimal Asthma controL (GOAL) study. Allergy. 2008; 63:932–938. PMID: 18588561.

24. Bateman ED, Reddel HK, Eriksson G, Peterson S, Ostlund O, Sears MR, Jenkins C, Humbert M, Buhl R, Harrison TW, Quirce S, O'Byrne PM.the relationship between current control and future risk. J Allergy Clin Immunol. 2010; 125:600–608. 608.e1–608.e6. PMID: 20153029.

25. Buhl R, Vogelmeier C. Budesonide/formoterol maintenance and reliever therapy: a new treatment approach for adult patients with asthma. Curr Med Res Opin. 2007; 23:1867–1878. PMID: 17605896.

26. Neffen H, Fritscher C, Schacht FC, Levy G, Chiarella P, Soriano JB, Mechali D. Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey. Rev Panam Salud Publica. 2005; 17:191–197. PMID: 15826399.

27. Adachi M, Ohta K, Morikawa A, Nishima S, Tokunaga S, Disantostefano RL. Changes in asthma insights and reality in Japan (AIRJ) in 2005 since 2000. Arerugi. 2008; 57:107–120. PMID: 18349585.

28. Bourdin A, Doble A, Godard P. The Asthma Insights and Reality in the Maghreb (AIRMAG) study: perspectives and lessons. Respir Med. 2009; 103(Suppl 2):S38–S48. PMID: 20122628.

29. Cho SH, Kim YK, Chang YS, Kim SS, Min KU, Kim YY. Asthma insights and reality in Korea. Korean J Med. 2006; 70:69–77.

30. Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, Trung PL, Zhong NS, Zainudin N, Zainudin BM. Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study. J Allergy Clin Immunol. 2003; 111:263–268. PMID: 12589343.

31. Lai CK, Ko FW, Bhome A, DE Guia TS, Wong GW, Zainudin BM, Nang AN, Boonsawat W, Cho SH, Gunasekera KD, Hong JG, Hsu JY, Viet NN, Yunus F, Mukhopadhyay A. Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia. Respirology. 2011; 16:688–697. PMID: 21362102.

32. Boulet LP, Becker A, Bowie D, Hernandez P, McIvor A, Rouleau M, Bourbeau J, Graham ID, Logan J, Légaré F, Ward TF, Cowie RL, Drouin D, Harris SB, Tamblyn R, Ernst P, Tan WC, Partridge MR, Godard P, Herrerias CT, Wilson JW, Stirling L, Rozitis EB, Garvey N, Lougheed D, Labrecque M, Rea R, Holroyde MC, Fagnan D, Dorval E, Pogany L, Kaplan A, Cicutto L, Allen ML, Moraca S, FitzGerald JM, Borduas F. Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD. Can Respir J. 2006; 13(Suppl A):5–47. PMID: 16552449.

33. Kang MK, Kim BK, Kim TW, Kim SH, Kang HR, Park HW, Chang YS, Kim SS, Min KU, Kim YY, Cho SH. Physicians' preferences for asthma guidelines implementation. Allergy Asthma Immunol Res. 2010; 2:247–253. PMID: 20885909.

34. Stone TT, Schweikhart SB, Mantese A, Sonnad SS. Guideline attribute and implementation preferences among physicians in multiple health systems. Qual Manag Health Care. 2005; 14:177–187. PMID: 16027596.

35. Stone TT, Kivlahan CH, Cox KR. Evaluation of physician preferences for guideline implementation. Am J Med Qual. 1999; 14:170–177. PMID: 10452134.

36. Sullivan SD, Lee TA, Blough DK, Finkelstein JA, Lozano P, Inui TS, Fuhlbrigge AL, Carey VJ, Wagner E, Weiss KB. A multisite randomized trial of the effects of physician education and organizational change in chronic asthma care: cost-effectiveness analysis of the Pediatric Asthma Care Patient Outcomes Research Team II (PAC-PORT II). Arch Pediatr Adolesc Med. 2005; 159:428–434. PMID: 15867115.

37. Sarrell EM, Mandelberg A, Cohen HA, Kahan E. Compliance of primary care doctors with asthma guidelines and related education programs: the employment factor. Isr Med Assoc J. 2002; 4:403–406. PMID: 12073408.

38. Davis DA, Thomson MA, Oxman AD, Haynes RB. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. Jama. 1992; 268:1111–1117. PMID: 1501333.

39. Lougheed MD, Moosa D, Finlayson S, Hopman WM, Quinn M, Szpiro K, Reisman J. Impacts of a provincial asthma guidelines continuing medical education project: The Ontario Asthma Plan of Action's Provider Education in Asthma Care Project. Can Respir J. 2007; 14:111–117. PMID: 17372639.

40. Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes. JAMA. 1999; 282:867–874. PMID: 10478694.

41. Davis RS, Bukstein DA, Luskin AT, Kailin JA, Goodenow G. Changing physician prescribing patterns through problem-based learning: an interactive, teleconference case-based education program and review of problem-based learning. Ann Allergy Asthma Immunol. 2004; 93:237–242. PMID: 15478382.

42. White M, Michaud G, Pachev G, Lirenman D, Kolenc A, FitzGerald JM. Randomized trial of problem-based versus didactic seminars for disseminating evidence-based guidelines on asthma management to primary care physicians. J Contin Educ Health Prof. 2004; 24:237–243. PMID: 15709563.

43. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995; 274:700–705. PMID: 7650822.

44. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998; 317:465–468. PMID: 9703533.

45. Van Sickle D, Singh RB. A video-simulation study of the management of asthma exacerbations by physicians in India. Clin Respir J. 2008; 2:98–105. PMID: 20298314.

46. Lougheed MD, Olajos-Clow JG. Asthma care pathways in the emergency department. Curr Opin Allergy Clin Immunol. 2010; 10:181–187. PMID: 20431367.

47. Allen D, Gillen E, Rixson L. Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances? Int J Evid Based Healthc. 2009; 7:61–74. PMID: 21631848.

48. Wazeka A, Valacer DJ, Cooper M, Caplan DW, DiMaio M. Impact of a pediatric asthma clinical pathway on hospital cost and length of stay. Pediatr Pulmonol. 2001; 32:211–216. PMID: 11536450.

49. Norton SP, Pusic MV, Taha F, Heathcote S, Carleton BC. Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study. Arch Dis Child. 2007; 92:60–66. PMID: 16905562.

50. Guttmann A, Zagorski B, Austin PC, Schull M, Razzaq A, To T, Anderson G. Effectiveness of emergency department asthma management strategies on return visits in children: a populationbased study. Pediatrics. 2007; 120:e1402–e1410. PMID: 18055658.

51. Dalcin Pde T, da Rocha PM, Franciscatto E, Kang SH, Menegotto DM, Polanczyk CA, Barreto SS. Effect of clinical pathways on the management of acute asthma in the emergency department: five years of evaluation. J Asthma. 2007; 44:273–279. PMID: 17530525.

52. Bailey R, Weingarten S, Lewis M, Mohsenifar Z. Impact of clinical pathways and practice guidelines on the management of acute exacerbations of bronchial asthma. Chest. 1998; 113:28–33. PMID: 9440564.

53. Lougheed MD, Olajos-Clow J, Szpiro K, Moyse P, Julien B, Wang M, Day AG. Multicentre evaluation of an emergency department asthma care pathway for adults. CJEM. 2009; 11:215–229. PMID: 19523270.

54. Ting S. Multi-colored simplified asthma guideline reminder: why pragmatic asthma tools are needed in real-world practice. Clin Rev Allergy Immunol. 2004; 27:133–145. PMID: 15576897.

55. Ting S. Multicolored simplified asthma guideline reminder (MSAGR) for better adherence to national/global asthma guidelines. Ann Allergy Asthma Immunol. 2002; 88:326–330. PMID: 11926628.

56. O'Laughlen MC, Hollen P, Ting S. An intervention to change clinician behavior: Conceptual framework for the multicolored simplified asthma guideline reminder (MSAGR). J Am Acad Nurse Pract. 2009; 21:417–422. PMID: 19689437.

57. Renzi PM, Ghezzo H, Goulet S, Dorval E, Thivierge RL. Paper stamp checklist tool enhances asthma guidelines knowledge and implementation by primary care physicians. Can Respir J. 2006; 13:193–197. PMID: 16779463.

58. Shapiro A, Gracy D, Quinones W, Applebaum J, Sarmiento A. Putting guidelines into practice: improving documentation of pediatric asthma management using a decision-making tool. Arch Pediatr Adolesc Med. 2011; 165:412–418. PMID: 21536955.

59. Campbell J, Campbell S, Woodward G. Getting evidence into practice using an asthma desktop tool. Aust Fam Physician. 2006; 35:32–33. PMID: 16489383.

60. Kuilboer MM, van Wijk MA, Mosseveld M, van der Does E, de Jongste JC, Overbeek SE, Ponsioen B, van der Lei J. Computed critiquing integrated into daily clinical practice affects physicians' behavior--a randomized clinical trial with AsthmaCritic. Methods Inf Med. 2006; 45:447–454. PMID: 16964364.

61. Kuilboer MM, van Wijk MA, Mosseveld M, van der Does E, Ponsioen BP, de Jongste JC, Overbeek SE, van der Lei J. Feasibility of AsthmaCritic, a decision-support system for asthma and COPD which generates patient-specific feedback on routinely recorded data in general practice. Fam Pract. 2002; 19:442–447. PMID: 12356691.

62. Twiggs JE, Fifield J, Jackson E, Cushman R, Apter A. Treating asthma by the guidelines: developing a medication management information system for use in primary care. Dis Manag. 2004; 7:244–260. PMID: 15669584.

63. Cho SH, Jeong JW, Park HW, Pyun BY, Chang SI, Moon HB, Kim YY, Choi BW. Effectiveness of a computer-assisted asthma management program on physician adherence to guidelines. J Asthma. 2010; 47:680–686. PMID: 20632781.

64. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998; 280:1339–1346. PMID: 9794315.

65. Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc. 1999; 6:104–114. PMID: 10094063.