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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

Summary

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.

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