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Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial.

Zwarenstein M, Bheekie A, Lombard C, Swingler G, Ehrlich R, Eccles M, Sladden M, Pather S, Grimshaw J, Oxman AD - Implement Sci (2007)

Bottom Line: We compared intervention and control group children on the change in score from pre-to one-year post-intervention.Educational outreach was accepted by general practitioners and was effective.It could be applied to other health care quality problems in this setting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Keenan Research Center, Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Canada. merrick.zwarenstein@ices.on.ca

ABSTRACT

Background: Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice.

Methods: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices. Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention.

Results: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms.

Conclusion: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.

No MeSH data available.


Related in: MedlinePlus

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Figure 1: Support materials left behind for practitioner use.

Mentions: Private healthcare in Mitchells Plain is usually provided by solo doctors without nurse support operating from storefront practices in the community (Figure 1). There is no formal registration list or roster system, and patients may move between several sources of primary care, including public sector clinics. Payment for private care provided to adults employed in the formal economy and their families is usually made by their employer-based health insurance, but for the informally employed and unemployed, payment is made by the patient in cash at the time of consultation. The cost of a single private sector primary care consultation, including medications, is about one day of average earnings for Mitchells Plain residents [7]. Consultations with local general practitioners and members of the South African National Asthma Education Programme, an organisation of asthma and allergy professionals, identified improvement in the quality of primary care as a priority for children with asthma in this setting.


Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial.

Zwarenstein M, Bheekie A, Lombard C, Swingler G, Ehrlich R, Eccles M, Sladden M, Pather S, Grimshaw J, Oxman AD - Implement Sci (2007)

Support materials left behind for practitioner use.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2200659&req=5

Figure 1: Support materials left behind for practitioner use.
Mentions: Private healthcare in Mitchells Plain is usually provided by solo doctors without nurse support operating from storefront practices in the community (Figure 1). There is no formal registration list or roster system, and patients may move between several sources of primary care, including public sector clinics. Payment for private care provided to adults employed in the formal economy and their families is usually made by their employer-based health insurance, but for the informally employed and unemployed, payment is made by the patient in cash at the time of consultation. The cost of a single private sector primary care consultation, including medications, is about one day of average earnings for Mitchells Plain residents [7]. Consultations with local general practitioners and members of the South African National Asthma Education Programme, an organisation of asthma and allergy professionals, identified improvement in the quality of primary care as a priority for children with asthma in this setting.

Bottom Line: We compared intervention and control group children on the change in score from pre-to one-year post-intervention.Educational outreach was accepted by general practitioners and was effective.It could be applied to other health care quality problems in this setting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Keenan Research Center, Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Canada. merrick.zwarenstein@ices.on.ca

ABSTRACT

Background: Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice.

Methods: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices. Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention.

Results: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms.

Conclusion: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.

No MeSH data available.


Related in: MedlinePlus