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Improving paediatric asthma outcomes in primary health care: a randomised controlled trial
Shah S, Sawyer SM, Toelle BG, Mellis C, Peat JK, Lagleva M, Usherwood TP, Jenkins CR
The Medical Journal of Australia 2011 Oct;195(7):405-409
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; 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*

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.

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