Pediatric Asthma Management by Resident and Attending Physicians in a Suburban Hospital

In anticipation of the new asthma guidelines (National Heart Lung Blood Institute, Expert Panel Report III), we developed a survey to evaluate the consistency of care in patients with asthma between residents and attending physicians. A blinded questionnaire was distributed to all Pediatric and Medicine-Pediatric residents, attending physicians in the Pediatric resident clinic, and community Pediatricians in private practice. The survey focused on asthma education during clinic visits including: use of written instructions for mediations, review of inhaler technique, peak flow use, and distribution of written asthma action plans. A total of 340 surveys were mailed out to attending physicians, of which, 79 were completed and returned (23.8%). Additionally, 34 surveys were sent to resident physicians, with 18 completed (52.9%). The majority of all surveyed physicians provided written instructions regarding medication usage (78% residents, 86% attendings). Inhaler technique was reviewed by all attending and 76.5% of resident physicians. Peak flow meters were not consistently recommended (47.1% of residents, 32.9% attendings). Written asthma action plans were provided by 51.9% of attending and only 5.6% of resident physicians. Attending physicians tend to provide written asthma action plans more often than residents (p-value = 0.0015). There is a significant difference in asthma education provided by attending and resident physicians, most notably the use of written asthma action plans. Despite these differences, there is ample room for improvement in providing consistent asthma education in the outpatient setting.