Improving Paediatric Asthma Care : A Randomised Controlled

Trial
Shah S , Sawyer SM , Mellis CM , Toelle BG , Peat JK , Roydhouse JK , Lagleva M , Edwards P , Usherwood T , Clark NM , Jenkins CR
1 2 1 1,3 4 1 1 5 1 6 1,3

1 University of Sydney, NSW, 2 Royal Children’s Hospital, VIC, 3 Woolcock Institute of Medical Research, NSW, 4 Australian Catholic University, NSW,
5 University of New South Wales, NSW, 6 University of Michigan, MI, USA

Introduction Results
Written asthma action plans (WAAPs), patient education, and regular review Fig. 1 GP CONSORT Diagram Fig. 4 Patient CONSORT Diagram Summary of Number Needed to Train in PACE to benefit 1 patient
are key components of paediatric asthma management
However, research consistently identifies a gap between best practice and GPs: NNT
actual clinical care, with fewer than 25% of people with asthma having a Completion of Asthma Cycle of Care*, 3
WAAP1
Communication and education skills enhance the capacity of clinicians to Prescribing a spacer device 4
effectively engage patients in self management
Providing written action plan>70% of time 4
 We designed a structured behaviour change program for general
practitioners (GPs) based on:
• the best available evidence and Child with persistent asthma using ICS 4
• the Physician Asthma Care Education (PACE) program in the USA2 Child with infrequent asthma not on ICS 4
PACE USA was successfully adapted to the Australian context for GPs3
Written action plan in last 12 months 5

AIM * a government initiative to encourage asthma education and patient review

Fig. 5 Paediatric patient outcomes: 15 % more children in the

The aim of the current study was to measure the impact of the new
Conclusion
intervention group received a WAAP
PACE (Practitioner Asthma Communication and Education) Australia
program on GP and patient outcomes Fig. 2 GP patient management: GPs more likely to provide
Favours intervention
WAAPs than control GPs P=0.03
Received a plan
PACE Australia led to improved outcomes in :
Methods
in last 12 months
Favours intervention
Provide asthma action
plan >70% of time
P<0.0001 Favours intervention  GP communication skills & asthma care
Setting: GPs from two areas in Sydney, Australia Gave written instructions to
Child days from P=0.63
adjust medication at home
very often or always P=0.01 school or daycare  provision and ownership of written asthma action plans
Design: Randomized controlled trial
Recruitment:
Increased use of
Asthma Cycle of Care P=0.004 Parent days P=0.54  more appropriate prescribing of ICS, LABA and devices
from work
 GPs: Invited by email and/or fax using contact lists from local GP
Prescribe asthma devices
> 90% of time P=0.01 These results provide high level evidence that the PACE
organizations, followed by a personal approach. Have carer demonstrate asthma
device very often/always P=0.002
-20 0 20 40 Australia intervention is effective and maybe useful for other
Difference intervention - control group and 95% CI
 Patients: Identified by GPs. Inclusion criteria: age 2-14 years, health professionals
diagnosed asthma, only one child per family, parental fluency in 0 10 20 30 40 50 60 Fig. 4 Use of ICS by asthma classification
English Difference intervention - control group and 95% CI
PACE Australia is also inexpensive to run costing only
Intervention: GP attendance at 2 X 3-hour workshops $200AUD per GP.
Measures at baseline and 12 months post intervention: Fig. 3 Intervention GPs rated higher confidence,
helpfulness and frequency of use of the 10 communication Fig 6. More appropriate use of ICS and LABA in
 GPs: Self-administered questionnaires children following the intervention
References
strategies
 Patients (parents): Telephone interview with trained independent
Favours intervention
interviewers
Confidence 1. Australian Centre for Asthma Monitoring, AIHW, 2008
Outcomes: P=0.03
Favours intervention
Infrequent intermittent 2. Clark et al., Pediatrics 1998, European Respiratory Journal 2005
 GPs: WAAP, GP communication behaviour; adherence to guidelines symptoms P=0.03 3. Shah et al., Australian Journal of Primary Health, 2010
Helpfulness
 Patients: WAAP, medication use, work and school days missed P=0.04

Acknowledgements
Frequent intermittent
symptoms P=0.82
Analysis: Frequency
P=0.03 Favours intervention
 Intention to treat.
Persistent symptoms
P=0.71
 Absolute difference between intervention –control group, adjusted for Funding: Australian Government Department of Health and Ageing
0 10 20 30 40 50
baseline using logistic regression (binary variables) & analysis of under the Asthma Management Program
Difference intervention - control group and 95% CI -40 -20 0 20 40 60 80
covariance (ordered variables). Difference intervention - control group and 95% CI We thank the participating GPs, patients and presenters at PACE workshops
 No adjustment for clustering as interclass correlations for main
outcomes were negligible.