Translation of an evidence-based asthma intervention: Physician Asthma Care Education (PACE) in the United States and Australia

Abstract

Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric asthma outcomes. To examine translation of PACE to Australia. The RE-AIM framework was used to assess translation. Demographic characteristics and findings regarding clinical asthma outcomes from PACE randomised clinical trials in both countries were examined. Qualitative content analysis was used to examine fidelity to intervention components. Both iterations of PACE reached similar target audiences (general practice physicians and paediatric patients with asthma); however, in the USA, more children with persistent disease were enrolled. In both countries, participation comprised approximately 10% of eligible physicians and 25% of patients. In both countries, PACE deployed well-known local physicians and behavioural scientists as facilitators. Sponsorship of the programme was provided by professional associations and government agencies. Fidelity to essential programme elements was observed, but PACE Australia workshops included additional components. Similar outcomes included improvements in clinician confidence in developing short-term and long-term care plans, prescribing inhaled corticosteroids, and providing written management instructions to patients. No additional time was spent in the patient visit compared with controls. US PACE realised reductions in symptoms and healthcare use, results that could not be confirmed in Australia because of limitations in follow-up time and sample sizes. US PACE is maintained through a National Heart, Lung, and Blood Institute website. Development of maintenance strategies for PACE Australia is underway. Based on criteria of the RE-AIM framework, the US version of PACE has been successfully translated for use in Australia.