Yousaf Khan, Ziaullah, Anila Basit, Arshad Javaid.
Do guidelines change practice? Survey of the management attitude and awareness of Chest Specialists and trainees towards asthma.
Pak J Chest Med Jun ;14(1):13-20.

Clinical guidelines for medical practice can contribute to improved health care delivery only if the document succeeds in not only enhance the practitioners` knowledge but brings about a change in their attitude and practice in accordance with the recommendations of the guidelines. Objective: To assess the impact of asthma guidelines on the knowledge, attitudes and practice of chest specialists and trainees. Methods: This was an interventional, questionnaire-based study, performed in two phases among doctors from all over Pakistan. First phase was carried out during 5th biennial conference in 2002 before launching of asthma guidelines by Pakistan chest society (PCS). The same study was repeated after two years in next biennial conference in 2004. Data was compared using chi square test to see any difference. Results: Sixty six doctors participated in both the groups. There were some differences in the scores relating to knowledge of asthma, attitudes of the doctors and their practice of treating asthma in the two groups, but the differences were small and not statistically significant. Significant differences were noted in the area of knowledge regarding reversibility in airway remodeling of asthma. Eight (13 %) correct responses in group I and 11 (17 %) in group II: (p < 0.05). The score in the use of spirometry for assessment of asthma severity improved, 9 (14 %) in group I and 27 (41 %) in group II (p < 0.05). Long term use of oral beta-2 agonists in the treatment of mild persistent asthma reduced from 20 (30 %,) in group Ito 14 (21 %) in group II: (p < 0.05). Teaching of inhaler technique was given more importance and was taught by trained technicians, 7 (11 %) in group I and 16 (24 %) in group II (p < 0.05) rather than leaving it to the chemist or the patient, 3 (4 %) in group I and nil in group II (p < 0.05). The practice of recommending desensitization to asthmatic patients increased from nil in group Ito 14 (21 %) in group II (p < 0.05). Conclusion: There were some deficiencies in the good understanding of asthma patho physiology, some lack of awareness and failure to practice ideally before the launch of PCS asthma guidelines. There was no significant change in those areas two years after the publications of these guidelines.

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