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Improved preventive care for asthma: a randomized trial of clinician prompting in pediatric offices
Jill S Halterman1, Susan Fisher, Kelly M Conn
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Insights
Clinician prompts significantly improved preventive asthma care delivery. Prompted visits were more likely to include action plans and asthma discussions, enhancing child asthma management.
Area of Science:
- Pediatric Medicine
- Respiratory Health
- Clinical Interventions
Background:
- Effective preventive asthma care is crucial for managing childhood asthma.
- Current delivery of preventive asthma care in pediatric settings can be inconsistent.
- Clinician prompting may enhance adherence to asthma guidelines.
Purpose of the Study:
- To evaluate if clinician prompting improves preventive asthma care delivery.
- To assess the impact of prompts on specific preventive actions for children with asthma.
Main Methods:
- A randomized controlled trial was conducted in two inner-city pediatric practices.
- 226 children (aged 2-12 years) with persistent asthma were randomized.
- The intervention involved providing clinicians with a prompt detailing symptom severity and guideline recommendations.
Main Results:
- Clinician prompting increased the likelihood of any preventive asthma action (87% vs. 69%).
- Prompted visits showed higher rates of action plan delivery (50% vs. 24%) and asthma discussions (87% vs. 76%).
- Children in the prompting group had threefold greater odds of receiving preventive care.
Conclusions:
- Clinician prompting is an effective strategy to improve preventive asthma care.
- Implementing prompts at the point of care can enhance guideline adherence and patient outcomes.
- This intervention offers a practical approach to optimizing asthma management in pediatric practices.
Objective:
To determine whether clinician prompting regarding a child's symptom severity and guideline recommendations at the time of an office visit improves the delivery of preventive asthma care.
Design:
Randomized controlled trial.
Setting:
Two inner-city pediatric practices in Rochester, NY.
Participants:
Two hundred twenty-six children with persistent asthma (aged 2-12 years) presenting to the clinics for well-child care, asthma care, or non-asthma-related illness care. Intervention We assigned children randomly to a clinician-prompting group (single-page prompt including the child's symptoms and guideline recommendations given to the clinician at the time of the visit) or a standard-care group (no prompt given). Interviewers called parents after the visit to inquire about preventive measures taken, and medical charts were reviewed.
Main Outcome Measures:
Any preventive action related to asthma taken at the visit.
Results:
Children in the clinician-prompting group were more likely to have had any preventive measures taken at the visit compared with children in the standard-care group (87% vs 69%). Specifically, visits for children in the clinician-prompting group were more likely to include delivery of an action plan (50% vs 24%), discussions regarding asthma (87% vs 76%), and recommendations for an asthma follow-up visit (54% vs 37%). In a regression model, children in the clinician-prompting group had 3-fold greater odds of receiving any preventive action compared with the standard-care group.
Conclusion:
Clinician prompting regarding asthma severity and care guidelines at the time of an office visit significantly improved the delivery of preventive asthma care.
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