Original Articles
Knowledge of and Attitudes and Adherence to the Spanish Guidelines for Asthma Management (GEMA) Among Spanish Health Care Professionals: The GEMA TEST Project
Vicente Plazaa,
, Ignasi Bolívarb, Jordi Ginera, María Antonia Llaugerc, Antolín López-Viñad, José Antonio Quintanoe, Joaquín Sanchisa, Montserrat Torrejóna, José Ramón Villaf
Corresponding author
vplaza@santpau.es
Correspondence: Dr V. Plaza Departament de Pneumologia Hospital de la Santa Creu i Sant Pau Sant Antoni M. Claret, 167 08025 Barcelona, Spain
Correspondence: Dr V. Plaza Departament de Pneumologia Hospital de la Santa Creu i Sant Pau Sant Antoni M. Claret, 167 08025 Barcelona, Spain
a Departamento de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Servicio de Epidemiología Clínica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
c Equip d'Atenció Primària Encants (CAP Maragall), Institut Català de la Salut (ICS), Barcelona, Spain
d Servicio de Neumología, Clínica Puerta de Hierro, Madrid, Spain
e Atención Primaria, Centro de Salud, Lucena, Córdoba, Spain
f Sección de Neumología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Quintano, Joaquín Sanchis, Montserrat Torrejón, José Ramón Villa" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Vicente" "apellidos" => "Plaza" "email" => array:1 [ 0 => "vplaza@santpau.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Ignasi" "apellidos" => "Bolívar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Jordi" "apellidos" => "Giner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "María Antonia" "apellidos" => "Llauger" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 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=> array:3 [ "entidad" => "Departamento de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Epidemiología Clínica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Equip d'Atenció Primària Encants (CAP Maragall), Institut Català de la Salut (ICS), Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Clínica Puerta de Hierro, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Atención Primaria, Centro de Salud, Lucena, Córdoba, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 5 => array:3 [ "entidad" => "Sección de Neumología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr V. Plaza Departament de Pneumologia Hospital de la Santa Creu i Sant Pau Sant Antoni M. Claret, 167 08025 Barcelona, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-02-27" "fechaAceptado" => "2007-07-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155241" "palabras" => array:3 [ 0 => "Asthma" 1 => "Asthma therapy" 2 => "Spanish guidelines for the management of asthma (GEMA)" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155240" "palabras" => array:3 [ 0 => "Asma" 1 => "Guías de tratamiento del asma" 2 => "Guía Española para el Manejo del Asma (GEMA)" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Health care professionals' adherence to asthma guidelines is believed to be low. The aim of the present study was to determine the knowledge, attitudes, and adherence of Spanish health care professionals with respect to the Spanish Guidelines for Asthma Management (GEMA).</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A multiple choice test with 15 questions was constructed. Items assessed knowledge of and opinions and adherence to asthma guidelines in general and the GEMA in particular. Test completion was voluntary, individual, and anonymous.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 1066 physicians and nurses took the test. The sample consisted of 241 (22.6%) respiratory medicine specialists and 244 (22.9%) nurses from the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), 221 (20.7%) pediatric pulmonologists from the Spanish Society of Pediatric Pulmonology (SENP), 220 (20.6%) general practitioners from the Spanish Society of Family and Community Medicine (semFYC), 181 (17%) general practitioners from the Spanish Society of Rural and General Medicine (SEMERGEN), and 38 (3.6%) others. Asthma guidelines were considered useful or very useful by 805 (76%), and 771 (72%) stated they were familiar with the GEMA. However, 388 (36%) admitted that they followed guidelines seldom or never. The level of adherence to the GEMA was poor for 243 (30.3%) respondents. The multivariate analysis revealed that low adherence was associated with the following characteristics: coming from the geographic center or south of Spain; being a primary care physician, unfamiliar with guidelines, or unconvinced of their utility; and not being a user of spirometry.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Even though the majority of Spanish health care professionals surveyed seem to know of the GEMA, their adherence to those guidelines is very low. Educational programs that seek to improve knowledge of asthma guidelines should consider the profile of professionals with low adherence to the GEMA so as to include educational strategies that target them specifically.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Se sospecha que el seguimiento de las recomendaciones terapéuticas del asma entre los profesionales sanitarios es bajo. El presente estudio se ha realizado con el objeto de determinar la opinión, el conocimiento y cumplimiento de las recomendaciones de la Guía Española para el Manejo del Asma (GEMA) entre los profesionales sanitarios españoles.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se elaboró un cuestionario de 15 preguntas de respuesta múltiple que recogían la opinión y conocimiento general sobre las guías de asma, el grado de seguimiento de éstas y, específicamente, de las recomendaciones diagnósticas y terapéuticas de la GEMA. El cuestionario se cumplimentó de forma voluntaria, individual y anó-nima.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Rellenaron el cuestionario 1.066 profesionales: 241 (22,6%) neumólogos y 244 (22,9%) profesionales de enfermería de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR); 221 (20,7%) pediatrasneumólogos de la Sociedad Española de Neumología Pediátrica (SENP); 220 (20,6%) médicos de atención primaria de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC); 181 (17%) médicos de atención primaria de la Sociedad Española de Medicina Rural y Generalista (SEMERGEN), y 38 (3,6%) de otras sociedades. De ellos, 805 (76%) opinaron que las guías para el manejo del asma eran útiles o muy útiles y 771 (72%) conocían la GEMA, pero 388 (36%) reconocían que seguían poco o nunca sus recomendaciones. Entre los médicos participantes, 243 (30,3%) fueron clasificados como malos cumplidores de la GEMA. El análisis multivariante reveló que los profesionales provenientes de las áreas centro y sur españolas, los de atención primaria, los poco convencidos de la utilidad de las guías o los que no las conocen, y los que no empleaban la espirometría se asociaron con un menor cumplimiento de la guía.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Si bien la mayoría de los profesionales sanitarios españoles encuestados conoce y estima positiva la GEMA, el grado de cumplimiento de ésta es bajo. Los futuros programas docentes encaminados a difundir las guías de asma deberían considerar el perfil del médico no cumplidor de la GEMA e incorporar estrategias educativas dirigidas específicamente a dichos profesionales.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía Española para el Manejo del Asma (GEMA)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en calidad de Comité Ejecutivo de la GEMA y en representación del grupo de redactores" "etal" => true "autores" => array:6 [ 0 => "V Plaza Moral" 1 => "FJ Álvarez Gutiérrez" 2 => "P Casan Clarà" 3 => "N Cobos Barroso" 4 => "A López Viña" 5 => "MA Llauger Rosselló" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2003" "volumen" => "39" "numero" => "Supl 5" "paginaInicial" => "1" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14587516" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global Strategy for Asthma Management and Prevention. 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| 2021 November | 23 | 41 | 64 |
| 2021 October | 33 | 53 | 86 |
| 2021 September | 19 | 63 | 82 |
| 2021 August | 23 | 44 | 67 |
| 2021 July | 16 | 31 | 47 |
| 2021 June | 21 | 33 | 54 |
| 2021 May | 23 | 28 | 51 |
| 2021 April | 36 | 90 | 126 |
| 2021 March | 27 | 32 | 59 |
| 2021 February | 24 | 26 | 50 |
| 2021 January | 33 | 29 | 62 |
| 2020 December | 42 | 28 | 70 |
| 2020 November | 21 | 27 | 48 |
| 2020 October | 11 | 14 | 25 |
| 2020 September | 12 | 9 | 21 |
| 2020 August | 49 | 17 | 66 |
| 2020 July | 29 | 21 | 50 |
| 2020 June | 21 | 14 | 35 |
| 2020 May | 19 | 27 | 46 |
| 2020 April | 23 | 19 | 42 |
| 2020 March | 20 | 14 | 34 |
| 2020 February | 27 | 23 | 50 |
| 2020 January | 23 | 21 | 44 |
| 2019 December | 25 | 19 | 44 |
| 2019 November | 15 | 7 | 22 |
| 2019 October | 5 | 10 | 15 |
| 2019 September | 11 | 20 | 31 |
| 2019 August | 19 | 13 | 32 |
| 2019 July | 16 | 19 | 35 |
| 2019 June | 10 | 9 | 19 |
| 2019 May | 15 | 18 | 33 |
| 2019 April | 9 | 13 | 22 |
| 2019 March | 13 | 15 | 28 |
| 2019 February | 10 | 8 | 18 |
| 2019 January | 5 | 4 | 9 |
| 2018 December | 7 | 10 | 17 |
| 2018 November | 14 | 12 | 26 |
| 2018 October | 26 | 15 | 41 |
| 2018 September | 12 | 8 | 20 |
| 2018 May | 6 | 0 | 6 |
| 2018 April | 12 | 7 | 19 |
| 2018 March | 6 | 4 | 10 |
| 2018 February | 8 | 9 | 17 |
| 2018 January | 12 | 10 | 22 |
| 2017 December | 4 | 7 | 11 |
| 2017 November | 3 | 6 | 9 |
| 2017 October | 11 | 14 | 25 |
| 2017 September | 3 | 8 | 11 |
| 2017 August | 11 | 17 | 28 |
| 2017 July | 6 | 9 | 15 |
| 2017 June | 15 | 9 | 24 |
| 2017 May | 10 | 7 | 17 |
| 2017 April | 11 | 3 | 14 |
| 2017 March | 38 | 28 | 66 |
| 2017 February | 5 | 5 | 10 |
| 2017 January | 2 | 2 | 4 |
| 2016 December | 8 | 7 | 15 |
| 2016 November | 11 | 6 | 17 |
| 2016 October | 16 | 6 | 22 |
| 2016 September | 16 | 5 | 21 |
| 2016 August | 11 | 3 | 14 |
| 2016 July | 11 | 3 | 14 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 37 | 10 | 47 |
| 2015 September | 26 | 11 | 37 |
| 2015 August | 45 | 11 | 56 |
| 2015 July | 39 | 7 | 46 |
| 2015 June | 30 | 6 | 36 |
| 2015 May | 43 | 10 | 53 |
| 2015 April | 32 | 10 | 42 |
| 2015 March | 37 | 13 | 50 |
| 2015 February | 39 | 3 | 42 |
| 2015 January | 31 | 4 | 35 |
| 2014 December | 33 | 7 | 40 |
| 2014 November | 32 | 7 | 39 |
| 2014 October | 58 | 9 | 67 |
| 2014 September | 35 | 5 | 40 |
| 2014 August | 29 | 6 | 35 |
| 2014 July | 29 | 11 | 40 |
| 2014 June | 33 | 8 | 41 |
| 2014 May | 66 | 12 | 78 |
| 2014 April | 44 | 4 | 48 |
| 2014 March | 41 | 8 | 49 |
| 2014 February | 43 | 7 | 50 |
| 2014 January | 32 | 8 | 40 |
| 2013 December | 40 | 9 | 49 |
| 2013 November | 31 | 7 | 38 |
| 2013 October | 43 | 6 | 49 |
| 2013 September | 38 | 5 | 43 |
| 2013 August | 35 | 5 | 40 |
| 2013 July | 48 | 10 | 58 |
| 2013 June | 41 | 8 | 49 |
| 2013 May | 36 | 6 | 42 |
| 2013 April | 18 | 9 | 27 |
| 2013 March | 8 | 5 | 13 |
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