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The influence of structured information and monitoring on the outcome of asthma treatment in primary care: a cluster randomized study
Nokela M, Heibert AM, Ehrs P-O, Krakau I, Forslund L, Wikstrom JE
Respiration 2010 Apr;79(5):388-394
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: In clinical trials of asthma, the outcomes are often good, but when the same treatment regimens are implemented in primary care, equally good results are not obtained. OBJECTIVE: To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control. METHODS: 141 patients from 19 primary care centres were studied. The centres were randomised to a standard care group or to an intervention group. The intervention group received structured written and oral information about asthma and asthma medication, and were instructed to keep an asthma diary. The primary outcome was asthma control as assessed by the Asthma Control Questionnaire. Secondary outcomes were costs of asthma medication, the Mini Asthma Quality of Life Questionnaire score and lung function. RESULTS: Asthma Control Questionnaire score changes differed between the study groups (p < 0.05). In the intervention group, these changes (mean -0.45) in asthma control were close to clinical significance (minimal important difference about 0.5). Both groups improved in disease-specific quality of life scores. For the intervention group, which changed the most (p < 0.05), the change exceeded the threshold for the minimal important difference (0.5). The costs of medications increased significantly in the intervention group, where adjustments of medication were made more often than in controls. CONCLUSION: Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to standard care.

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