|Year : 2016 | Volume
| Issue : 4 | Page : 1040-1043
Knowledge of family physicians regarding national egyptian guideline for management of bronchial asthma, Alexandria Governorate, Egypt
Hala M El Meselhy1, Fathia M Al Nemer2, Aml A Salama1, Mohammed Said3
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Family Medicine, Ministry of Health, Alexandria, Egypt
|Date of Submission||16-Jan-2015|
|Date of Acceptance||10-Apr-2015|
|Date of Web Publication||21-Mar-2017|
Aml A Salama
Department of Family Medicine, Faculty of Medicine, Shbeen El-koom District, Menoufia Governorate
Source of Support: None, Conflict of Interest: None
Assessment of family physician knowledge regarding management of bronchial asthma as included in the national clinical practical guidelines for family physicians.
Despite the development and dissemination of guidelines for the diagnosis and management of asthma, adherence to its recommendations is still suboptimal. Moreover, information is limited regarding adherence of the family physicians to the asthma guidelines in Egypt.
Materials and methods
A cross-sectional analytical study involving 82 family physicians engaged in direct asthma care in family health centers and units in Alexandria, Egypt. They were subjected to a self-designed questionnaire with multiple choices assessing their overall knowledge of bronchial asthma as recommended in the guidelines. The studied physicians were divided into two groups by years of experience in family medicine: group 1 with less than 5 years of experience in family medicine practice and group 2 with more than 5 years of experience. They were assessed using self-administered questionnaire with multiple choices.
This study was conducted on 82 family physicians in Alexandria Governorate. Assessment of family physician knowledge regarding the national Egyptian bronchial asthma clinical practical guidelines showed significant difference between the two groups regarding diagnosis of bronchial asthma, drugs used in the management of bronchial asthma, role of reliever inhalation, prescription of asthma medications and asking about asthma as preventable disease.
There are variations in family physicians' knowledge regarding recommendation of national Egyptian guidelines for bronchial asthma for diagnosis, grading, and management.
Keywords: bronchial asthma, guidelines, knowledge
|How to cite this article:|
El Meselhy HM, Al Nemer FM, Salama AA, Said M. Knowledge of family physicians regarding national egyptian guideline for management of bronchial asthma, Alexandria Governorate, Egypt. Menoufia Med J 2016;29:1040-3
|How to cite this URL:|
El Meselhy HM, Al Nemer FM, Salama AA, Said M. Knowledge of family physicians regarding national egyptian guideline for management of bronchial asthma, Alexandria Governorate, Egypt. Menoufia Med J [serial online] 2016 [cited 2020 Feb 22];29:1040-3. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1040/202502
| Introduction|| |
Bronchial asthma is one of the most common chronic diseases worldwide. Epidemiological studies showed high prevalence of asthma in children in many countries all over the globe , and the disease is associated with considerable morbidity and a significant economic burden for many countries .
Bronchial asthma is a disease characterized by ongoing inflammation of the airway, overproduction of mucus, and airway constriction due to tightened muscles, which results in permanent structural changes in the lungs, a condition often called airway remodeling. In turn , these changes usually lead to accelerated declines in lung function, including irreversible decreases in airflow because of narrowed air passages .
The prevalence of asthma among Egyptian children aged 3–15 years was estimated at 8.2%, and a major concern is the annual increase in mortality .
Despite these laudable efforts to improve asthma care over the past decade, most patients have not benefited from advances in asthma treatment, and many lack even the rudimentary care partly owing to the disease entity or patients' compliance and partly because of physicians' knowledge and disposition in terms of treatment .
Translating the asthma guidelines into clinical practice has been inadequate, and poor adherence to the guidelines has been documented at the physicians' level .
| Materials and Methods|| |
A cross-sectional analytical study was done involving family physicians in Alexandria Governorate. In total, two medical district were selected randomly to conduct this study: Al Montaza medical district and Central Alexandria medical district. All family physicians in family health centers and units in the randomly selected districts were included in the study by direct interview at the workplace. The total number of study sample was 96 physicians, and oral consent was taken from the participating physicians. Only 82 physicians responded and complete the questionnaires. The response rate was 85.4%. They were divided into two main groups by years of experience: group 1 with up to 5 years and group 2 with at least 5 years. Menoufia faculty of medicine committee for medical ethics of research and health authorities in Alexandria Governorate formally approved the study before it began. The exclusion criteria were physicians refusing to participate or complete the interview. Data were collected using predesigned questionnaire, which consisted of two main parts. The first part consists of 11 questions involving age, sex, years of experience in family practice, qualification, working place, work position, if they consider themselves able to manage childhood asthma, frequency of seeing patients with asthma, frequency of prescribing asthma medications, source of information about bronchial asthma, and if they have clinical practical guidelines (CPGs) for bronchial asthma in their office. The second part assessed the family physician's knowledge about bronchial asthma diagnosis and management as recommended in CPGs. It consisted of five questions to assess knowledge about CPGs for family physicians in general and the difference between guideline and protocol. Then 11 questions were administered about diagnosis of asthma, aim of control, treatment of bronchial asthma, use of reliever, immunotherapy, environmental control, and about grading of bronchial asthma severity according to the Egyptian guidelines for the management of asthma. Right answer was given the highest score, whereas wrong answers were given a score of 0.
The total scoring of all right answers of knowledge questions was subsequently classified as adequate or inadequate using scoring system.
Statistical management of the collected data
The data were tabulated and analyzed by statistical package of social science program (IBM Inc. Chicago, IL), version 20 using a personal computer. Qualitative data were expressed as number and percentage and analyzed by using c2-test. Quantitative data were expressed as mean + SD and analyzed by using t-test. (P = 0.001) was considered highly significant, P value up to 0.05 was considered significant, and P value more than 0.05 was considered insignificant.
| Results|| |
This cross-sectional study was conducted on 82 family physicians in Alexandria Governorate. In this study, 75.6% were female physicians, 54.9% were physicians older than 30 years, and 47.7% had master's or diploma degree in family medicine. The age and years of experience are significant between the two groups ([Table 1]).
|Table 1 Comparison of demographic data between family physicians according to years of experience|
Click here to view
This study shows significant difference between the two groups regarding diagnosis of bronchial asthma, drugs used in management of bronchial asthma, role of reliever inhalation, prescription of asthma medications, and asking about asthma as preventable disease ([Table 2]).
|Table 2 Comparison between the studied groups regarding their knowledge about national clinical practice guideline of bronchial asthma|
Click here to view
It shows statistically significant difference regarding knowledge of family physicians of national Egyptian CPGs of bronchial asthma in relation to age, qualification, workplace, and frequency of prescribing bronchial asthma medications ([Table 3]).
|Table 3 Spearman's correlation of family physicians' knowledge regarding clinical practical guidelines of bronchial asthma and their demographic and general work characteristics|
Click here to view
The current study shows a significant correlation between family physician qualifications and their knowledge regarding CPGs. Higher knowledge scores were among master's degree and diploma-qualified family physicians.
There was a significant correlation between family physicians' workplaces (center or unit) and their knowledge scores. Higher scores were detected in family physicians working in family health centers than those working for health units.
| Discussion|| |
The integration of evidence-based guideline into the healthcare improves the quality of patient care. This study was conducted to assess the knowledge of family physicians in Alexandria Governorate regarding bronchial asthma diagnosis and management as recommended by the national Egyptian guideline for family physicians.
Of the study sample of 96 physicians, 82 family physicians responded (response rate of 85.4%) and became eligible for the study.
The current study shows that there was a statistically significant correlation between the two studied groups regarding age and qualification. This finding is in agreement with another survey from Turkey  that aimed to evaluate the knowledge and practice of pediatricians about childhood asthma and its treatment; the study included 52 pediatricians who attended one of the seven meetings about asthma treatment and found that duration of practice and presence of private office influence knowledge and practice of general pediatricians. On the contrary, in this study, the results also did not differ regarding the respondents' age, sex, and mean number of years since medical school graduation.
This study shows that 70.7% of studied physicians have adequate knowledge about grading of bronchial asthma severity. In the survey that was conducted in Cairo , 84.9% were able to grade bronchial asthma severity adequately. In the study done in Incheon, Korea, the authors reported that 51.3% of study sample were able to classify bronchial asthma severity . In an another study, based on the national heart, lung, and blood institute guidelines, Doerschug et al. developed a multiple-choice test of asthma knowledge that was distributed to physicians at the University of Iowa; it found that physicians had a poor understanding of the asthma severity staging system and appropriately staged the severity in only 46% of the patients .
This study shows that 45.1 and 89.0% of study physicians have adequate knowledge about drugs and reliever inhalation in the management of bronchial asthma. Another study done in Iran  reported that 61.7% of participant physicians had adequate knowledge about role of reliever inhalation in the management of bronchial asthma.
The knowledge of family physicians regarding bronchial asthma guidelines shows statistical significant correlation related to age, qualification, workplace, and frequency of prescribing bronchial asthma medications, on agreement with the study done in Cairo, Egypt  significant correlation between qualification and knowledge. Another study reported that specialists have more knowledge of select conditions, were more likely to use medications associated with better survival, and were more likely to comply with screening guidelines .
| Conclusion|| |
The years of experience of physicians in family practice significantly affect knowledge of national CPGs of bronchial asthma regarding diagnosis, drugs used in management, and role of reliever in Alexandria, Egypt. Age and qualification of physicians have significant correlation with their adequate knowledge regarding CPGs.
Many thanks to physicians who accepted to participate in this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. Global variation inthe prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009; 64
Rozpoznawania S. Global strategy for asthma management and prevention. Wydanie specjalne 2007; 1
El-Nemr FM, Al-Ghndour MI. Study on the use of impulse oscillometry in the evaluation of children with asthma. Menoufia Med J 2013; 26
Global initiative for asthma: 2013 update: global strategy for asthma management and prevention. Available at: [http://www.ginasthma.org
]. [Last accessed on 2014 Sep 15].
Masoli M, Fabian D, Holt S, Beasley R. Global initiative for asthma (GINA) program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59
Georgy V, Fahim HI, El Gaafary M, Walters S. Prevalence and socioeconomic associations of asthma and allergic rhinitis in nothern Africa. Eur Respir J 2006; 28
Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008; 31
Yilmaz O, Sogut A, Alkan S, Yuksel H. Knowledge and practice Of general pediatricians about childhood bronchial asthma and its treatment. Turk Arch Ped 2009; 44
Salama A, Mohammed A, El okda E, Said R. Quality of care of Egyptian asthmatic children clinicians adherence to asthma guidelines. Ital J Pediatr 2010; 36
Sun YH, Eun BW, Sim SY, Ch KH, Ryoo E, Choi DY, et al.
Poor adherence and reasons for nonadherence to the asthma guidelines among pediatricians in Korea: Asian Pac J Allergy Immunol 2010; 28
Doerschug KC, Peterson MW, Dayton CS, Kline JN. Asthma guidelines: an assessment of physician understanding and practice. Am J Respir Crit Care Med 1999; 159
Gharagozlou M, Abdollahpour H, Moinfar Z, Bemanian MH, Sedaghat M. A survey of pediatricians' knowledge on asthma management in children. Iran J Allergy Asthma Immunol 2008; 7
[Table 1], [Table 2], [Table 3]