Randomised Controlled Trial of a Multi-faceted Community-based Intervention to Improve Asthma in Children
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional
Phase: Phase 4

Summary: 
      The objectives of this trials are to demonstrate, in children with poorly controlled asthma,
      that an intervention to increase the awareness and the impact of poor asthma control among
      parents and physicians of affected children and adolescents can reduce the rate of asthma
      emergency visits in the 12 months following the initiation of the intervention.
    

Detailed description: 
      In the philosophy of the "Programs to integrate information service and manage
      education(PRIISME)", the proposed randomised controlled trial will examine a novel approach
      based on education to trigger practice changes in community physicians and pharmacists as
      well as behavioural changes in parents of poorly controlled asthmatic children and in
      adolescents. Poorly controlled asthmatic children will be identified among those who present
      to the emergency department of the Montreal Children's Hospital for an acute asthma
      exacerbation. The novel approach hinges on alerting parents, physicians, pharmacists, and,
      for adolescents, the patients themselves, of the actual degree of asthma control and its
      impact on usual activities. The instrument used, the Asthma Quiz for Kidz, is a brief 5-item
      questionnaire based on the Canadian Asthma Consensus statement.

      The tested intervention is comprised of (1) notifying by mail the treating physician of: the
      index emergency department or hospital admission, the results on the Asthma Quiz for Kidz in
      the month preceding the index exacerbation, the orientation of the patient to his/her local
      Asthma Education Centre (AEC), and the treatment protocol of the Canadian Asthma Consensus
      statement and providing a prescription pad containing the Asthma Impact Checklist; (2)
      referring the parents and child or adolescent to a personalised educational session with a
      highly trained asthma educator approved by the AEC, at a site identified closest to home or
      work; giving them a refrigerator magnet of the Asthma Quiz for Kidz; trimestrial mailing the
      5-item Asthma Quiz for Kidz with a simple guide to interpret the degree of control,
      re-enforcing the message that control can be improved, and reminding them to consult their
      physician; (3) providing the identified AEC educator with a standard form, to be mailed to
      the treating physician and the co-ordinating centre, on which to record the results on the
      Asthma Quiz for Kidz, the interventions and recommendations made to the parents pertaining to
      environment, drug use, need to consult MD for an action plan; (4) providing pharmacists with
      a pad of the Asthma Quiz for Kidz to administer to identified patients at each request to
      refill asthma drugs.

      The control intervention is the current usual care with referral of all hospitalised patients
      to the Montreal Children's Hospital (MCH) asthma educator (current attendance rate of 30%)
      and referral of non-hospitalised children to the MCH Asthma Centre, at the discretion of the
      emergency physicians.

      The primary outcome is the rate of emergency department visits in the 12 months
      post-randomisation. Secondary outcomes include others measures of health care resources
      utilisation (hospital admission, physician's visits), measures of appropriateness of asthma
      drug use (refill rate of reliever drugs, ratio of inhaled preventer/reliever drugs, rate of
      rescue systemic steroids), and quality of life measures (for the school-aged child and the
      caregiver).

      If proven effective in reducing asthma morbidity, the current strategy may be implemented at
      relatively low cost, relative to the savings in health care expenditures for poorly
      controlled asthmatic children. This intervention could then be tested in other populations
      and settings.
    

Intervention name(s): asthma control awareness; Usual care
Intervention type(s): Procedure; Procedure
Intervention description(s): Repeated assessments of the child's asthma control using the Asthma Quiz for Kidz, with recommendation for asthma education and medical visit; Recommendation for asthma education and/or follow-up at the physician's discretion
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: asthma; children; adolescent; education; medical review; asthma control; questionnaire; quality of life; emergency department visit; use of medication; adherence to treatment