Elsevier

Academic Pediatrics

Volume 12, Issue 4, July–August 2012, Pages 312-318
Academic Pediatrics

Asthma
Improving Clinician Self-Efficacy Does Not Increase Asthma Guideline Use by Primary Care Clinicians

https://doi.org/10.1016/j.acap.2012.04.004Get rights and content

Abstract

Objective

The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).

Methods

A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy.

Results

At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04–1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29–1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92–3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes.

Conclusions

Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.

Section snippets

Methods

Twenty-four pediatric practices (8 urban and 16 private) in central Connecticut completed baseline measures that examined clinician self-efficacy and stages of change related to asthma, in addition to other measures, and were randomized into a control or provider intervention arm (Figure).32, 33

A practice was eligible to participate if the clinicians had been previously trained in the Easy Breathing program, which has been described.34, 35 The Easy Breathing program at this time consisted of 4

Study Participants

Eighty-eight clinicians in 24 practices were randomized either into the provider arm (n = 44 clinicians, 12 practices) or the control arm (Figure; Table 2). Eighteen clinicians (two-thirds were MLPs) left their practice before the end of the study. Their data were used at baseline only. Two thirds of the clinicians were full time physicians and one-third were MLPs. Seventy-five percent of physicians and 40% of MLPs had received their highest degree more than 10 years previously with a mean

Discussion

For all participants in this study, higher asthma-related self-efficacy scores at baseline were associated with greater asthma program-related activity (ie, enrollment in Easy Breathing). Self-efficacy scores and readiness to change increased in clinicians in the intervention arm but these increases were not associated with an increase in program enrollment, in increased development of a written asthma treatment plan, or with greater use of anti-inflammatory therapy for persistent asthma.

The

Acknowledgments

This work was supported by the National Heart Lung and Blood Institute of the National Institutes of Health (RO1 HL 70785-01) (Michelle M. Cloutier).

We are grateful to Ms Pamela Higgins for programmatic support, Ms Trudy Lerer and Ms Autherene Grant for data analysis and entry, and Ms Michelle Morse for administrative support and to the practices, clinicians, and staff who participated in this project.

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