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Proactive asthma care in childhood: general practice based randomised controlled trial
Nicholas J Glasgow1, Anne-Louise Ponsonby, Rachel Yates
1Academic Unit of General Practice and Community Care, Canberra Clinical School of the University of Sydney, PO Box 254, Canberra, ACT 2614, Australia. Nicholas.Glasgow@calvary-act.com.au
Insights
A proactive asthma care system in general practice improved asthma management for children. This approach led to more consultations, written asthma plans, and reduced emergency visits, demonstrating its feasibility and benefits.
Area of Science:
- Pediatric respiratory medicine
- General practice and primary care
- Health services research
Background:
- Asthma management in children often relies on reactive care.
- A proactive, systematic approach integrated into general practice may improve outcomes.
- Feasibility and effectiveness of such a system require evaluation.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a proactive, general practice-based asthma care system for children.
- To assess the impact of a structured care plan (the 3+ visit plan) with active recall on pediatric asthma management.
Main Methods:
- A randomized controlled trial using cluster sampling of general practices.
- 174 children with moderate to severe asthma participated.
- The intervention involved a structured 3+ visit plan with active patient recall.
Main Results:
- Children in the intervention group had significantly more asthma consultations, written asthma plans, and completed care plans.
- A significant reduction in forced expiratory volume in one second after cold air challenge was observed in the intervention group.
- Emergency department visits for asthma and speech-limiting wheeze were reduced in the intervention group.
Conclusions:
- A proactive asthma care system with active recall is feasible within general practice settings.
- This proactive approach demonstrates benefits for children with moderate to severe asthma.
- The findings support the integration of systematic, proactive asthma management into primary care.
Objectives:
To assess the feasibility and effectiveness of a general practice based, proactive system of asthma care in children.
Design:
Randomised controlled trial with cluster sampling by general practice.
Setting:
General practices in the northern region of the Australian Capital Territory.
Participants:
174 children with moderate to severe asthma who attended 24 general practitioners.
Intervention:
System of structured asthma care (the 3+ visit plan), with participating families reminded to attend the general practitioner.
Main Outcome Measures:
Process measures: rates for asthma consultations with general practitioner, written asthma plans, completion of the 3+ visit plan; clinical measures: rates for emergency department visits for asthma, days absent from school, symptom-free days, symptoms over the past year, activity limitation over the past year, and asthma drug use over the past year; spirometric lung function measures before and after cold air challenge.
Results:
Intervention group children had significantly more asthma related consultations (odds ratio for three or more asthma related consultations 3.8 (95% confidence interval 1.9 to 7.6; P = 0.0001), written asthma plans (2.2 (1.2 to 4.1); P = 0.01), and completed 3+ visit plans (24.2 (5.7 to 103.2); P = 0.0001) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6% (1.7 to 3.5); P = 0.0001) less than control children. The number needed to treat (benefit) for one additional written asthma action plan was 5 (3 to 41) children. Intervention group children had lower emergency department attendance rates for asthma (odds ratio 0.4 (0.2 to 1.04); P = 0.06) and less speech limiting wheeze (0.2 (0.1 to 0.4); P = 0.0001) than control children and were more likely to use a spacer (2.8 (1.6 to 4.7); P = 0.0001). No differences occurred in number of days absent from school or symptom-free day scores.
Conclusions:
Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial.
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