Pediatricians' attitudes and behaviors toward asthma monitoring devices in an urban setting

Background: Asthma is the most common chronic pediatric illness in the United States, affecting approximately 25% of children in an urban population. Although current National Asthma Education and Prevention Program (NAEPP) guidelines clearly recommend the use of peak flow meters (PFMs), asthma action plans (AAPs), and spirometry in asthma management, poor adherence among physicians has been reported. Objective: In an area with one of the highest prevalence of asthma nationwide, we studied the adherence of pediatricians to NAEPP guidelines as well as their attitudes and behaviors regarding asthma monitoring devices. Design/Methods: A questionnaire was designed to collect information about pediatricians' demographics, practice patterns, and use of asthma monitoring devices. General pediatricians, who were members of the Brooklyn Pediatric Society of New York, were asked to respond anonymously. The data were then analyzed. Results: The questionnaire was mailed to 106 pediatricians of whom 57 responded (54%); 89% were in practice for >10 years and 96% worked in an urban setting. Although 88% reported that they used the NAEPP guidelines, only 37% used PFM, 83% wrote AAP, and 19% used spirometry. Of physicians who reported monitoring devices improved their clinical judgment, 58% still did not use PFM and 81% did not use spirometry. The most common reason cited was that they took too much time to perform. Pediatricians who treated more patients were more likely to use PFM (p ≤ .05) and spirometry (p ≤ .05). Only 16% and 42% of pediatricians stated that they would refer their mild persistent and moderate persistent asthmatics for subspecialty evaluation, respectively. Years since graduating medical school and practice type did not affect usage of monitoring devices among pediatricians. Conclusions: Although the majority of pediatricians claim to adhere to NAEPP guidelines in this urban population of Brooklyn, NY, PFM, AAPs, and spirometry are underutilized. The most reported reason for their limited use is time constraint. However, pediatricians who cared for more asthmatics tended to use monitoring devices more. We speculate that underutilization might be one factor why urban children in Brooklyn are reported to have poorer asthma care and higher morbidity.