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Implementation of an asthma guideline for the management of childhood asthma in general practice: a randomised controlled trial
Hagmolen of ten Have W, van den Berg NJ, van der Palen J, van Aalderen WMC, Bindels PJE
Primary Care Respiratory Journal 2008 Jun;17(2):90-96
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*

AIM: The aim of the study was to assess, in a randomised, controlled design, the efficacy of different strategies to improve childhood asthma management. METHOD: Three interventions directed to three groups of general practitioners were compared: group A -- dissemination of a guideline; group B -- guideline dissemination plus an educational session; group C -- guideline dissemination, educational session, plus individualised treatment advice based on airway hyperresponsiveness (AHR) and symptoms. Efficacy of the three strategies was assessed by evaluating change in AHR in 362 children after one year. RESULTS: The overall between-group effect of the severity of AHR was not significantly different (p = 0.09). In groups A and C an improvement was seen in nocturnal symptoms (p = 0.02) and in group C an improvement was seen in the prescription of inhaled corticosteroids (p = 0.03). CONCLUSION: In this study, the combined implementation strategy did not show a clear improvement in the management of children with asthma in general practice.

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