Improving Provider Compliance in the Use of an Asthma Action Plan for Patients with Asthma in an Outpatient Setting

Abstract

Problem: Improved patient asthma outcomes, operationally defined as decreased acute care visits, reduced missed days from school and work, and decreased nocturnal awakenings due to asthma symptoms, have been demonstrated through the use of a symptom based written asthma action plan (AAP) in reducing acute care visits (Gibson & Powell, 2004; Zemek, Bhogal, & Ducharme, 2008). However, despite the research and guideline recommendations that support the use of AAPs, these plans are routinely not used by providers. In fact, only 25 percent to 56 percent of all asthma patients receive an AAP (Rank, Volcheck, Li, Patel, & Lim, 2008). Thus, the purpose of the Capstone project was to improve provider compliance in an outpatient office in the use of a symptom based AAP. Methods: The Capstone quality improvement (QI) project was conducted during a specific two month period (coinciding with the study period in the fall and winter of 2010) in a suburban outpatient allergy and asthma clinic in Glen Burnie, Maryland. The QI project involved an educational in-service on the use of an AAP and a system procedural change (placing a blank AAP on each patient’s medical record at the time of visit). A retrospective medical record review was conducted from all eligible medical records of patients greater than six years of age diagnosed with asthma that were seen in the office during the two month study period following the educational in-service in order to assess the use and completeness of the AAP (N = 42). The rate of proportional change (percentages) in compliance in the use of an AAP after the educational in-service and system procedural change was analyzed and reported. Results: A statistically significant improvement in provider compliance to the use and completion of a symptom based AAP was found at eight weeks following an educational in-service and system procedural change. A statistically significant change (p < .001) in provider IMPROVING PROVIDER ASTHMA ACTION PLAN COMPLIANCE 2 compliance was found as evidenced by a 79 percent (33/42) increase in the use and completion of a symptom based AAP following the intervention (education and system procedural change) as compared to less than 5 percent (2/42) rate of compliance prior to the intervention. Discussion: The role of the Doctor of Nursing Practice (DNP) is to synthesize the evidence and implement the best evidence and recommended national guidelines. The QI project paralleled the role of the DNP in the implementation of evidence based research and guidelines in conducting an educational in-service and system procedural change to improve provider compliance in the completion and use of a symptom based AAP within an organization. The project demonstrated the effectiveness of an educational in-service in improving provider compliance in the use of and the completion of a symptom based AAP.