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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 2: Trial flow diagram.

Mentions: The intervention was delivered during 1998 to individual practitioners by a pharmacist trained in the methods of academic detailing. A first visit took 30 minutes with a repeat visit of similar duration conducted three months later. At the first visit, the pharmacist used a visual aid, a set of printed glossy materials similar to those used by pharmaceutical company representatives, structured as a plastic laminated desk blotter, on which the key messages were outlined (Figure 2). The blotter was left behind in the practice, along with instructions for modifying a 500 ml plastic soft drink bottle to attach to a pressurised metered dose inhaler as a volume increasing spacer and an actual example of one such spacer. (Spacers reduce the difficulties children have in coordinating their breathing with triggering of the inhaler).


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)

Trial flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Trial flow diagram.
Mentions: The intervention was delivered during 1998 to individual practitioners by a pharmacist trained in the methods of academic detailing. A first visit took 30 minutes with a repeat visit of similar duration conducted three months later. At the first visit, the pharmacist used a visual aid, a set of printed glossy materials similar to those used by pharmaceutical company representatives, structured as a plastic laminated desk blotter, on which the key messages were outlined (Figure 2). The blotter was left behind in the practice, along with instructions for modifying a 500 ml plastic soft drink bottle to attach to a pressurised metered dose inhaler as a volume increasing spacer and an actual example of one such spacer. (Spacers reduce the difficulties children have in coordinating their breathing with triggering of the inhaler).

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