A patient-centered telephone intervention using the asthma action plan

Application of the patient-centered medical home (PCMH) practice model requires managing patients with chronic diseases, such as asthma, with patient-centered approaches that ensure appropriate ongoing assessment and treatment for all patients. The Asthma Control Score (ACS) and the Asthma Action Plan (AAP) are validated tools for assessment and management of asthma. ACS use by phone has been shown to accurately assess patients' asthma control; however, no studies to date demonstrate the utility of AAP implementation by phone to improve asthma control. This study tested the effectiveness of AAP implementation by phone to improve asthma control.

Adult patients with asthma (n=48) participating in a managed care insurance plan at a university-based family medicine residency clinic were enrolled in the study. Patients were contacted by phone, and an initial ACS was assessed. Patients with an ACS <20 (uncontrolled asthma) had their medication adjusted and a new AAP implemented by phone. Uncontrolled patients were reassessed by phone monthly and management was adjusted until control was achieved.

Of 48 patients, 42 (87.5%) were reached by phone. On initial assessment, 33 (69%) were controlled. After implementation of the new AAP by phone, seven of nine (78%) initially uncontrolled patients were controlled, for a total of 40 (83%) patients controlled by the end of the study.

Asthma management using the ACS and AAP by phone is a feasible strategy that is acceptable to patients and can improve asthma control without the need for an office visit.