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Implementation of Asthma Management Guidelines and Possible Barriers in Korea

Journal of Korean Medical Science 2020년 35권 12호 p.72 ~ 72
조은정, 김미영, 김세훈, 권용은, 박혜경, 조상헌, 장윤석,
소속 상세정보
조은정 ( Jo Eun-Jung ) - Pusan National University School of Medicine Department of Internal Medicine
김미영 ( Kim Mi-Yeong ) - Inje University College of Medicine Busan Paik Hospital Department of Internal Medicine
김세훈 ( Kim Sae-Hoon ) - Seoul National University College of Medicine Department of Internal Medicine
권용은 ( Kwon Yong-Eun ) - Chosun University Medical School Department of Internal Medicine
박혜경 ( Park Hye-Kyung ) - Pusan National University School of Medicine Department of Internal Medicine
조상헌 ( Cho Sang-Heon ) - Seoul National University College of Medicine Department of Internal Medicine
장윤석 ( Chang Yoon-Seok ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract


Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

키워드

Asthma; Guidelines; Implementation; Barrier; Inhaled Corticosteroid

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