• Michelle M Cloutier, Dorothy B Wakefield, Penelope S Carlisle, Howard L Bailit, and Charles B Hall.
• Pulmonary Division, Department of Pediatrics, University of Connecticut Health Center, Hartford, CT 06106, USA. mclouti@ccmckids.org
• Arch Pediat Adol Med. 2002 Oct 1;156(10):1045-51.

ObjectiveTo determine whether Easy Breathing, an asthma management program, improves adherence to national asthma guidelines.DesignBefore and after intervention trial.SettingSix urban primary care clinics in Hartford, Conn.ParticipantsThirty-four primary care physicians, 37 midlevel practitioners, 32 nurses, and 69 pediatric and family practice residents and medical students.InterventionsKnowledge was assessed before (pretest) and after (posttest) a training program and 12 to 18 months after (follow-up) implementing Easy Breathing. Questions were divided into factual, guideline recommendation, and guideline application.Main Outcome MeasuresThe percentage of correct responses on the pretest, posttest, and follow-up tests; clinician adherence to national guidelines; and clinician attitudes.ResultsThe percentage of correct responses on the pretest was higher for physicians (mean, 61%; 95% confidence interval [CI], 57%-65%) than for midlevel practitioners (mean, 54%; 95% CI, 50%-59%) (P=.01). Correct responses increased significantly on the posttest for physicians (mean, 77%; 95% CI, 74%-81%) in all 3 subgroups of questions (P<.001) and for midlevel practitioners (mean, 69%; 95% CI, 63%-75%) overall and for factual and guideline questions. On the follow-up test, improvements in factual and guideline responses disappeared for all clinicians but were sustained for applied questions (mean, 78% [95% CI, 63%-94%] for physicians and 65% [95% CI, 51%-78%] for midlevel practitioners). Adherence to prescribing guidelines after implementing Easy Breathing was 93% to 99% and was associated with a 3-fold increase in inhaled corticosteroid prescriptions. Physicians reported that they had integrated Easy Breathing into practice but did not think this represented a substantial change.ConclusionsEasy Breathing increases clinicians' knowledge and use of national guidelines. Primary care physicians believe they are adhering to guidelines even when they are not.

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