Improved Preventive Care for Asthma: A Randomized Trial of Clinician Prompting in Pediatric Offices

Abstract

Halterman JS, Fisher S, Conn KM, et al. Arch Pediatr Adolesc Med. 2006;160:1018–1025 PURPOSE OF THE STUDY. To determine if clinician prompting regarding asthma severity and guideline recommendations at the time of an office visit improves the delivery of preventive asthma care. STUDY POPULATION. Children aged 2 to 12 years (N = 226) with persistent asthma from 2 inner-city pediatric practices in Rochester, New York. Children were at the clinic for a well-child check, asthma care, or non–asthma-related illness care and were randomly assigned to 1 of 2 groups: clinician-prompting group (CPG) or standard-care group (SCG). METHODS. A baseline survey was conducted to obtain information regarding household demographics, medication use, and environmental tobacco-smoke exposure. Parents of the children who were randomly assigned to the CPG were instructed to give a prompt sheet to their clinician along with a blank asthma action plan form. Parents of the children who were assigned to the SCG also completed baseline assessment interviews but were not given a prompt sheet, and no information regarding the interview was shared with the clinician. Follow-up information was collected within 60 days through telephone interviews. RESULTS. The children in the CPG were more likely to have any preventive action related to asthma taken at the visit compared with children in the SCG (86.6% vs 69.3%). Children in the CPG were also more likely to have received an asthma action plan (50.0% vs 23.7%), recommendation for a specific asthma follow-up visit (53.6% vs 36.8%), discussion regarding asthma (75.0% vs 63.2%), and smoke-reduction counseling (57.5% vs 35.4%) compared with those in the SCG. There were no statistical differences in referrals for specialty care, treatment of comorbid conditions, or changes in preventive medications between the 2 groups. CONCLUSIONS. Clinician prompting regarding asthma severity and care guidelines at the time of an office visit increased the likelihood of delivering preventive asthma care. REVIEWER COMMENTS. Several studies have demonstrated that health care providers often underestimate asthma severity and have demonstrated poor adherence to National Asthma Education and Prevention Program guidelines. Successful management of asthma requires both accurate determination of asthma severity and proper treatment. This study demonstrates a method that may increase the likelihood of delivering preventive asthma care at non–asthma-related office visits by prompting clinicians. However, as the authors pointed out, although prompting improved the delivery of preventive asthma care, a large percentage of patients in the CPG did not have follow-up–visit recommendations (46.4%), received no asthma action plan (50%), and received no discussion related to asthma (25%). This study demonstrates that a better system needs to be implemented to increase the rate of delivering appropriate preventive care for patients with asthma.