Improving paediatric asthma outcomes in primary health care: a randomised controlled trial.

Abstract

OBJECTIVE: To evaluate the effectiveness of the Practitioner Asthma Communication and Education (PACE) Australia program, an innovative communication and paediatric asthma management program for general practitioners. DESIGN: Randomised controlled trial. SETTING: General practices from two regions in metropolitan Sydney. PARTICIPANTS: 150 GPs, who were recruited between 2006 and 2008, and 221 children with asthma in their care. INTERVENTION: GPs in the intervention group participated in two 3-hour workshops, focusing on communication and education strategies to facilitate quality asthma care. MAIN OUTCOME MEASURES: Patient outcomes included receipt of a written asthma action plan (WAAP), appropriate medication use, parent days away from work, and child days away from school or child care. GP outcomes included frequency of providing a WAAP and patient education, communication and teaching behaviour, and adherence to national asthma guidelines regarding medication use. RESULTS: More patients of GPs in the intervention group reported receipt of a WAAP (difference, 15%; 95% CI, 2% to 28%; adjusted P=0.046). In the intervention group, children with infrequent intermittent asthma symptoms had lower use of inhaled corticosteroids (difference, 24%; 95% CI, -43% to -5%; P=0.03) and long-acting bronchodilators (difference, 19%; 95% CI, -34% to -5%; P=0.02). GPs in the intervention group were more confident when communicating with patients (difference 22%; 95% CI, 3% to 40%; P=0.03). A higher proportion of GPs in the intervention group reported providing a WAAP more than 70% of the time (difference, 23%; 95% CI, 11% to 36%; adjusted P=0.002) and prescribing spacer devices more than 90% of the time (difference, 29%; 95% CI, 16% to 42%; adjusted P=0.02). CONCLUSIONS: The PACE Australia program improved GPs' asthma management practices and led to improvements in some important patient outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12607000067471.