Abstract
INTRODUCTION: Asthma is the most common chronic lung disease diagnosed in children in Brazil and represents a personal and social burden for subjects and their families and direct and indirect costs related to management of the disease. Although there are nationally-based initiatives to implement standards of care, it is supposed that a wide range of practices would be observed, especially when comparing family medicine practitioners and primary care pediatricians. AIMS AND OBJECTIVES: To explore and compare the process of care received by children with asthma served by primary care physicians (family medicine practitioners and primary care pediatricians) in Brazil. Subject and methods: A qualitative approach was used to study responses for cases assigned to family medicine practitioners and pediatricians through a mailed questionnaire with multiple-choice and open-ended questions. Three provider types were identified: Family medicine specialists, Family medicine non-specialists and primary-care pediatricians, all working in the Brazilian public, Unified Health System. Process of care measures reflecting aspects of care recommended in national guidelines were developed and used to analyze patterns of care across provider types, controlling for case-mix and other covariates. RESULTS: Management of asthma in children had a wide variation in terms of diagnosis, classification, pharmacological treatment in acute and maintenance care, educational and preventive measures and follow-up practices, inside each group of providers and through the distinct groups. Differences were significantly higher among Family Medicine specialists and non-specialists. Level of agreement of practitioners with guidelines and standards of care were low and dependant of age, years of experience in primary care, specialization and complexity of case. Use of evidence-based, services-oriented guidelines for caring of children with asthma is not disseminated. CONCLUSIONS: Continuing professional development in childhood asthma in Brazil is an issue to be concerned with, especially with the increment of access and coverage of public primary care services. Conflict of interest and funding None.