Effectiveness of a multi-level asthma intervention in increasing controller medication use: a randomized control...

Area of Science:

• Pediatric Asthma Management
• Public Health Interventions
• Healthcare Disparities

Background:

• Poor family self-management contributes to high asthma morbidity in Puerto Rico.
• The prior CALMA intervention improved asthma outcomes but not controller medication use.
• CALMA-plus was developed to enhance CALMA with provider training and clinic-based screening.

Purpose of the Study:

• To evaluate the efficacy of the CALMA-plus intervention compared to CALMA-only.
• To determine if CALMA-plus increases controller medication use in pediatric asthma patients.
• To assess the impact on asthma symptom reduction and service utilization.

Main Methods:

• 404 children with asthma from Medicaid claims data in San Juan, Puerto Rico were included.
• Eight clinics were paired and randomized to either CALMA-only or CALMA-plus interventions.
• Outcomes were assessed at 12 months post-intervention.

Main Results:

• No statistically significant difference was found between CALMA-plus and CALMA-only for controller medication use.
• Small, non-significant differences favored CALMA-plus for decreasing asthma symptoms.
• Both intervention groups demonstrated reduced asthma symptoms and service utilization.

Conclusions:

• Provider compliance, limited clinic numbers, and medication barriers may explain the lack of difference.
• Future interventions require enhanced provider support and resources for successful implementation.
• The study highlights the need for tailored strategies to improve pediatric asthma care in underserved populations.