Improving paediatric asthma outcomes in primary health care: a randomised controlled trial

Smita Shah, Susan M Sawyer, Brett G Toelle, Craig M Mellis, Jennifer K Peat, Marivic Lagleva, Timothy P Usherwood and Christine R Jenkins
Med J Aust 2011; 195 (7): 405-409. || doi: 10.5694/mja10.11422


Objective: To evaluate the effectiveness of the Practitioner Asthma Communication and Education (PACE) Australia program, an innovative communication and paediatric asthma management program for general practitioners.

Design: Randomised controlled trial.

Setting: General practices from two regions in metropolitan Sydney.

Participants: 150 GPs, who were recruited between 2006 and 2008, and 221 children with asthma in their care.

Intervention: GPs in the intervention group participated in two 3-hour workshops, focusing on communication and education strategies to facilitate quality asthma care.

Main outcome measures: Patient outcomes included receipt of a written asthma action plan (WAAP), appropriate medication use, parent days away from work, and child days away from school or child care. GP outcomes included frequency of providing a WAAP and patient education, communication and teaching behaviour, and adherence to national asthma guidelines regarding medication use.

Results: More patients of GPs in the intervention group reported receipt of a WAAP (difference, 15%; 95% CI, 2% to 28%; adjusted P = 0.046). In the intervention group, children with infrequent intermittent asthma symptoms had lower use of inhaled corticosteroids (difference, 24%; 95% CI, 43% to 5%; P = 0.03) and long-acting bronchodilators (difference, 19%; 95% CI, 34% to 5%; P = 0.02). GPs in the intervention group were more confident when communicating with patients (difference 22%; 95% CI, 3% to 40%; P = 0.03). A higher proportion of GPs in the intervention group reported providing a WAAP more than 70% of the time (difference, 23%; 95% CI, 11% to 36%; adjusted P = 0.002) and prescribing spacer devices more than 90% of the time (difference, 29%; 95% CI, 16% to 42%; adjusted P = 0.02).

Conclusions: The PACE Australia program improved GPs’ asthma management practices and led to improvements in some important patient outcomes.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12607000067471.

  • Smita Shah1
  • Susan M Sawyer2
  • Brett G Toelle3
  • Craig M Mellis4
  • Jennifer K Peat5
  • Marivic Lagleva1
  • Timothy P Usherwood6
  • Christine R Jenkins3

  • 1 Primary Health Care Education and Research Unit, Westmead Hospital, University of Sydney, Sydney, NSW.
  • 2 Department of Paediatrics, University of Melbourne, Melbourne, VIC.
  • 3 Woolcock Institute of Medical Research, Sydney, NSW.
  • 4 Central Clinical School, University of Sydney, Sydney, NSW.
  • 5 School of Exercise Science, Australian Catholic University, Sydney, NSW.
  • 6 Department of General Practice, Sydney Medical School — Westmead, University of Sydney, Sydney, NSW.

Competing interests:

No relevant disclosures.

  • 1. Australian Centre for Asthma Monitoring. Asthma in Australia 2008. Canberra: Australian Institute of Health and Welfare, 2008. (AIHW Asthma Series No. 3; AIHW Cat. No. ACM 14.)
  • 2. Shah S, Roydhouse JK, Sawyer SM. Asthma education in primary healthcare settings. Curr Opin Pediatr 2008; 20: 705.
  • 3. Dinakar C, Van Osdol TJ, Wible K. How frequent are asthma exacerbations in a pediatric primary care setting and do written asthma action plans help in their management? J Asthma 2004; 41: 807-812.
  • 4. Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax 2004; 59: 94.
  • 5. Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust 2004; 180 (6 Suppl): S57-S60. <MJA full text>
  • 6. Goeman DP, Hogan CD, Aroni RA, et al. Barriers to delivering asthma care: a qualitative study of general practitioners. Med J Aust 2005; 183: 457-460. <MJA full text>
  • 7. Sawyer SM, Shah S. Improving asthma outcomes in harder-to-reach populations: challenges for clinical and community interventions. Paediatr Respir Rev 2004; 5: 207-213.
  • 8. Barton C, Proudfoot J, Amoroso C, et al. Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines. Prim Care Respir J 2009; 18: 100-105.
  • 9. Roydhouse JK, Shah S, Toelle BG, et al. A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice. Aust J Primary Health 2011; 17: 288-293.
  • 10. Shah S, Toelle BG, Sawyer SM, et al. Feasibility study of a communication and education asthma intervention for general practitioners in Australia. Aust J Prim Health 2010; 16: 75-80.
  • 11. Glasgow N. Systems for the management of respiratory disease in primary care-an international series: Australia. Prim Care Respir J 2008; 17: 19-25.
  • 12. Clark NM, Gong M, Kaciroti N. A model of self-regulation for control of chronic disease. Health Educ Behav 2001; 28: 769-782.
  • 13. Clark NM, Gong M, Schork MA, et al. Impact of education for physicians on patient outcomes. Pediatrics 1998; 101: 831-836.
  • 14. Centre for Epidemiology and Research, New South Wales Department of Health. New South Wales child health survey 2001. N S W Public Health Bull 2002; 13 Suppl 3: 1-84.
  • 15. Donner A, Klar N. Design and analysis of cluster randomization trials in health research. London: Arnold, 2000.
  • 16. National Asthma Council Australia. Asthma management handbook 2006. Melbourne: National Asthma Council Australia, 2006.
  • 17. Sulaiman ND, Barton CA, Liaw ST, et al. Do small group workshops and locally adapted guidelines improve asthma patients’ health outcomes? A cluster randomized controlled trial. Fam Pract 2010; 27: 246-254.
  • 18. Hoddinott P, Britten J, Harrild K, Godden DJ. Recruitment issues when primary care population clusters are used in randomised controlled clinical trials: climbing mountains or pushing boulders uphill? Contemp Clin Trials 2007; 28: 232-241.


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