Glasgow, NJ and Ponsonby, AL and Yates, R and Beilby, J and Dugdale, P, Proactive asthma care in childhood: general practice based randomised controlled trial, British Medical Journal, 327, (7416) pp. 659-666. ISSN 0959-535X (2003) [Refereed Article]
Objectives: To assess the feasibility and effectiveness of a general practice based, proactive system of asthma care in children.
Design: Randomised controlled trial with cluster sampling by general practice.
Setting: General practices in the northern region of the Australian Capital Territory.
Participants: 174 children with moderate to severe asthma who attended 24 general practitioners.
Intervention: System of structured asthma care (the 3+ visit plan), with participating families reminded to attend the general practitioner.
Main outcome measures: Process measures: rates for asthma consultations with general practitioner, written asthma plans, completion of the 3+ visit plan; clinical measures: rates for emergency department visits for asthma, days absent from school, symptom-free days, symptoms over the past year, activity limitation over the past year, and asthma drug use over the past year; spirometric lung function measures before and after cold air challenge.
Results: Intervention group children had significantly more asthma related consultations (odds ratio for three or more asthma related consultations 3.8 (95% confidence interval 1.9 to 7.6; P = 0.0001), written asthma plans (2.2 (1.2 to 4.1); P = 0.01), and completed 3+ visit plans (24.2 (5.7 to 103.2); P = 0.0001) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6% (1.7 to 3.5); P = 0.0001) less than control children. The number needed to treat (benefit) for one additional written asthma action plan was 5 (3 to 41) children. Intervention group children had lower emergency department attendance rates for asthma (odds ratio 0.4 (0.2 to 1.04); P = 0.06) and less speech limiting wheeze (0.2 (0.1 to 0.4); P = 0.0001) than control children and were more likely to use a spacer (2.8 (1.6 to 4.7); P = 0.0001). No differences occurred in number of days absent from school or symptom-free day scores.
Conclusions: Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial.
|Item Type:||Refereed Article|
|Research Division:||Health Sciences|
|Research Field:||Epidemiology not elsewhere classified|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Ponsonby, AL (Professor Anne Ponsonby)|
|Web of Science® Times Cited:||43|
|Deposited By:||Menzies Centre|
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