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A randomized controlled trial of an asthma clinical pathway for children in general practice
E A Mitchell1, P B Didsbury, N Kruithof
1Department of Paediatrics, University of Auckland, New Zealand. e.mitchell@auckland.ac.nz
Insights
Implementing an asthma clinical pathway in general practice showed no significant reduction in childhood asthma hospitalizations or emergency visits. While some medication prescribing patterns shifted, the pathway
Area of Science:
- Pediatric Pulmonology
- General Practice Research
- Clinical Pathway Implementation
Background:
- Asthma management in children requires effective clinical pathways.
- General practice plays a crucial role in pediatric asthma care.
- Evaluating the impact of standardized care protocols is essential.
Purpose of the Study:
- To assess the effectiveness of an asthma clinical pathway for children in general practice settings.
- To determine if pathway implementation reduces asthma-related morbidity.
- To analyze changes in asthma medication prescribing.
Main Methods:
- A randomized controlled trial involving 270 general practitioners.
- Intervention group implemented an asthma clinical pathway; control group received usual care.
- Primary outcomes included hospital admissions and emergency department visits for asthma; compliance assessed via prescriptions.
Main Results:
- Hospital admissions for asthma decreased in all groups, but differences were not statistically significant.
- Emergency department attendance for asthma also decreased across groups, without statistical significance.
- Prescriptions for several asthma medications decreased, with a significant difference favoring the intervention group for oral relievers.
Conclusions:
- While asthma-related hospitalizations and emergency visits decreased, the asthma clinical pathway did not demonstrate a statistically significant benefit over usual care.
- Changes in medication prescribing aligned with pathway recommendations, particularly for oral relievers.
- Further investigation is needed to understand why the pathway did not yield statistically significant improvements in morbidity outcomes.
Aims:
To evaluate the effect of the implementation of an asthma clinical pathway on asthma in children in general practice.
Methods:
A randomized, controlled trial involving 270 general practitioners. One group of general practitioners implemented the asthma clinical pathway for children (intervention group) and the control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at the Children's Emergency Department. Compliance with the guidelines was assessed by examining asthma drug prescriptions.
Results:
Admissions to hospital for asthma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The differences between the intervention and control and between the intervention and non-participating general practitioners were not statistically significant. The decrease in attendance at the Children's Emergency Department decreased by 25%, 30% and 19%, respectively, but this was not statistically significant. There was a significant decrease in prescriptions for oral relievers, dry powder relievers in the under 6s, mast cell stabilizers and methylxanthines in both control and intervention groups. However, only for oral relievers was there a significant difference between the intervention group and control, with the decrease larger in the intervention group (p < 0.001).
Conclusions:
Admissions to hospital for asthma decreased, as did attendance at the Children's Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with compliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practitioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioners were already providing care according to the recommendations of the pathway, or that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineffective.
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