Adherence to national guidelines for children with asthma at primary health centres in Sweden: potential for improvement

Background: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. Aims: To evaluate adherence to national guidelines for primary care management of children with asthma. Methods: This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. Results: Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). Conclusions: This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines. (C) 2012 Primary Care Respiratory Society UK. All rights reserved. M Jonsson et al. Prim Care Respir J 2012; 21(3): 276-282 http://dx.doi.org/10.4104/pcrj.2012.00051