The effect of easy breathing on asthma management and knowledge

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.