Jill S Halterman1, Maria Fagnano1, Paul J Tremblay1, Susan G Fisher2, Hongyue Wang3, Cynthia Rand4, Peter Szilagyi1, Arlene Butz5. 1. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. 2. Department of Clinical Sciences, Temple University, Philadelphia, Pennsylvania. 3. Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York. 4. Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland. 5. Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.
Abstract
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.
RCT Entities:
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.
Authors: Jill S Halterman; H Lorrie Yoos; Jeffrey M Kaczorowski; Kenneth McConnochie; Robert J Holzhauer; Kelly M Conn; Sherri Lauver; Peter G Szilagyi Journal: Arch Pediatr Adolesc Med Date: 2002-02
Authors: Ian A Scott; Charles P Denaro; Cameron J Bennett; Annabel C Hickey; Alison M Mudge; Judy L Flores; Daniela C J Sanders; Justine M Thiele; Beres Wenck; John W Bennett; Mark A Jones Journal: Med J Aust Date: 2004-05-17 Impact factor: 7.738
Authors: Jill S Halterman; Peter G Szilagyi; H Lorrie Yoos; Kelly M Conn; Jeffrey M Kaczorowski; Robert J Holzhauer; Sherri C Lauver; Tia L Neely; Patrick M Callahan; Kenneth M McConnochie Journal: Arch Pediatr Adolesc Med Date: 2004-05
Authors: Scott R Weingarten; James M Henning; Enkhe Badamgarav; Kevin Knight; Vic Hasselblad; Anacleto Gano; Joshua J Ofman Journal: BMJ Date: 2002-10-26
Authors: Pamela R Wood; Jordan C Kampschmidt; Peter H Dube; Marianna P Cagle; Paola Chaparro; Norma S Ketchum; Thirumalai R Kannan; Harjinder Singh; Jay I Peters; Joel B Baseman; Edward G Brooks Journal: Ann Allergy Asthma Immunol Date: 2017-06-19 Impact factor: 6.347
Authors: Nicolas P N Goldstein; Sean M Frey; Maria Fagnano; Sande O Okelo; Jill S Halterman Journal: Acad Pediatr Date: 2017-09-09 Impact factor: 3.107