Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
J Korean Med Sci. 2020 Mar 30;35(12):e72. doi: 10.3346/jkms.2020.35.e72.
There could be a gap between asthma management guidelines and current practice. We evaluated the awareness of and compliance with asthma management guidelines, and the internal and external barriers to compliance, for the first time in Korea.
From March to September of 2012, 364 physicians treating asthma patients at primary, secondary, and tertiary teaching hospitals were enrolled. They completed a questionnaire on the awareness of and compliance with asthma management guidelines, and the barriers and alternatives to their implementation.
Of the 364 physicians, 79.1% were men and 56.9% were primary care physicians. The mean age was 40.5 ± 11.2 years. Most of them were aware of asthma management guidelines (89.3%). However, only a portion (11.0%) of them complied with the guidelines for asthma. Pulmonary function tests for diagnosis of asthma were performed by 20.1% of all physicians and 9.2% of primary care physicians, and by 9.9% of all physicians and 5.8% of primary care physicians for monitoring. Physicians stated that 'asthma monitoring' was the most difficult part of the guidelines, followed by 'environmental control and risk factors.' Only 39.6% (31.9% of the primary care physicians) prescribed an inhaled corticosteroid (ICS) as the first-line treatment for persistent asthma. The internal barriers were physician's preference for oral medications, difficulty in use even with inhaler training, and concern over ICS side effects. The external barriers were possible rejection of medical reimbursement by health insurance, refusal by the patient, cost, and a poor environment for teaching the patient how to use the inhaler. Alternatives proposed by physicians to implement asthma management guidelines were to improve medical reimbursement policies and the level of awareness of such guidelines.
Compliance with the asthma management guidelines, including ICS prescription, is low despite the awareness of the guidelines. It is necessary to develop a strategy to overcome the internal and external barriers.
哮喘管理指南与当前实践之间可能存在差距。我们首次在韩国评估了哮喘管理指南的知晓率和依从性，以及依从性的内部和外部障碍。
2012 年 3 月至 9 月，共招募了 364 名在初级、二级和三级教学医院治疗哮喘患者的医生。他们完成了一份关于哮喘管理指南的知晓率和依从性以及实施障碍和替代方案的问卷。
在 364 名医生中，79.1%为男性，56.9%为初级保健医生。平均年龄为 40.5±11.2 岁。他们大多数都了解哮喘管理指南（89.3%）。然而，只有一部分（11.0%）的人遵守了哮喘指南。所有医生中有 20.1%和初级保健医生中有 9.2%进行肺功能检查以诊断哮喘，所有医生中有 9.9%和初级保健医生中有 5.8%进行肺功能检查以监测哮喘。医生表示，指南中“哮喘监测”是最困难的部分，其次是“环境控制和危险因素”。只有 39.6%（初级保健医生中的 31.9%）将吸入皮质类固醇（ICS）作为持续性哮喘的一线治疗药物。内部障碍是医生对口服药物的偏好、即使经过吸入器训练也难以使用以及对 ICS 副作用的担忧。外部障碍可能是医疗保险拒绝报销医疗费用、患者拒绝、费用和患者使用吸入器教学环境差。医生提出的实施哮喘管理指南的替代方案是改善医疗报销政策和此类指南的认知水平。
尽管了解指南，但对哮喘管理指南（包括 ICS 处方）的依从性较低。有必要制定一项策略来克服内部和外部障碍。
