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Published on: August 24, 2010
Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial
Jill S Halterman1, Maria Fagnano1, Paul J Tremblay1
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Insights
The Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) improved preventive asthma care and reduced symptoms in urban children at 2 months. However, symptom reduction was not sustained at 6 months.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Health Services Research
Background:
- Asthma disproportionately affects impoverished and minority children, who often receive suboptimal preventive care.
- Urban children with persistent or poorly controlled asthma face significant morbidity.
Purpose of the Study:
- To evaluate the effectiveness of the PAIR-UP intervention in improving preventive asthma care delivery and reducing morbidity in urban children.
- To assess the impact of a primary care-based intervention on asthma management for high-risk pediatric populations.
Main Methods:
- A cluster randomized trial involving 12 urban primary care practices, randomly assigned to PAIR-UP intervention or usual care (UC).
- 638 children (aged 2-12) with persistent/poorly controlled asthma were enrolled.
- The PAIR-UP intervention included prompts for caregivers and clinicians, educational resources, and performance feedback; UC received asthma guidelines.
Main Results:
- The PAIR-UP group showed significantly higher rates of preventive medication actions, asthma action plan receipt, asthma discussions, and secondhand smoke counseling compared to UC.
- At 2-month follow-up, children in the PAIR-UP group experienced more symptom-free days (SFDs) per 2 weeks (mean difference: 0.78 days).
- The improvement in SFDs was not statistically significant at the 6-month follow-up (mean difference: 0.56 days).
Conclusions:
- The PAIR-UP intervention effectively enhanced the delivery of preventive asthma care and reduced asthma morbidity in high-risk urban children at 2 months.
- While initial improvements were observed, the sustained impact on symptom-free days was not significant at 6 months, suggesting a need for ongoing support or modified interventions.
Importance:
A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care.
Objective:
To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma.
Design, Setting, And Participants:
Cluster randomized trial in which 12 urban primary care practices were matched based on size and type and randomly allocated to the PAIR-UP intervention or usual care (UC). We enrolled 638 children aged 2 to 12 years with persistent or poorly controlled asthma in the waiting room prior to a visit with a clinician for any reason from October 2009 to January 2013. Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit and called them 2 and 6 months later to assess symptoms.
Interventions:
Children enrolled at PAIR-UP practices received prompts for the caregiver and clinician at the time of the visit that outlined the child's asthma severity or control as well as specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. The UC practices received copies of the asthma guidelines.
Main Outcomes And Measures:
The primary outcome was symptom-free days (SFDs) per 2 weeks at the 2-month follow-up.
Results:
We enrolled 638 children (participation rate of 80%; 36% were black, 36% were Hispanic, and 68% had Medicaid insurance). Groups were similar in demographic characteristics and asthma severity at baseline. At the index visit, more children in the PAIR-UP group received a preventive medication action (new medication, increased dose, recommendation to restart preventive medication) than in the UC group (58% vs 33%; odds ratio [OR] = 2.8; 95% CI, 1.9 to 3.9). More children in the PAIR-UP group than in the UC group received an asthma action plan (61% vs 23%; OR = 8.3; 95% CI, 3.7 to 18.7), discussions regarding asthma (93% vs 78%; OR = 4.5; 95% CI, 2.8 to 7.2), and secondhand smoke counseling (80% vs 63%; OR = 2.6; 95% CI, 1.2 to 5.5). At the 2-month follow-up, children in the PAIR-UP group had more SFDs per 2 weeks than those in the UC group (mean difference, 0.78 days; 95% CI, 0.29 to 1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference, 0.56; 95% CI, -0.14 to 1.25).
Conclusions And Relevance:
The PAIR-UP intervention improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma at 2 months, but the improvement in SFDs was no longer significant at 6 months.
Trial Registration:
clinicaltrials.gov Identifier: NCT01105754.
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