Effectiveness of a Multi-level Clinic and Family Asthma Intervention With a Randomized Control Trial
Condition: Infantile Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The aim of this group-randomized trial was to test the effectiveness of a new comprehensive
      program, which the investigators called CALMA -plus, in increasing controller medication use
      and reducing asthma symptoms. CALMA-plus involved the CALMA home-based family intervention,
      plus educational training of physicians and nurses, as well as screening for asthma in
      clinics serving Medicaid island Puerto Rican children with asthma. Because the provider
      training was expected to have an impact on the entire clinical setting where trained
      providers work, as well as the patients using that setting, the investigators randomized
      clinic groups rather than individual patients. The investigators compared the CALMA-Plus
      intervention to a CALMA-only group, which the investigators expected to obtain the same
      benefits as the investigators have previously documented.
    

Detailed description: 
      Puerto Rico has high rates of pediatric asthma and morbidity associated in part with poor
      family asthma management and low rates of controller medication use. A previous study found a
      family management intervention called CALMA to be effective in reducing asthma symptoms and
      service utilization. However, CALMA was not effective in increasing the use of controller
      medications. CALMA- plus was developed to address this issue by adding to CALMA components of
      educational training of physicians and nurses, and screening for asthma in clinics serving
      Medicaid Puerto Rican children with persistent asthma. A total of 404 children in eight
      clinics were studied after forming four pairs of clinics and randomizing the clinics (1:1) to
      CALMA-only or CALMA-plus within each pair. After adjusting for clinic variation, the study
      failed to demonstrate that the CALMA-plus intervention was more efficacious than the CALMA-
      only intervention for increasing reported controller medication use or decreasing symptoms in
      children with persistent asthma. Both groups had lower rates of asthma symptoms and service
      utilization consistent with previous results of the CALMA-only intervention. Limitations of
      the study were small number of clinics available, comparison of the experimental intervention
      with an evidence based intervention, and limited exposure to some aspects of the
      intervention. More effective interventions may include aggressive case management, and
      providing the physician with more relevant information.
    

Intervention name(s): CALMA plus; CALMA
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants received a family education intervention (previously tested) known as CALMA plus physician education and organizational change of the clinics were addressed with a culturally tailored program developed by adapting content from several evidence-based provider training programs; Family Education Intervention on management of pediatric asthma
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment