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September 7, 2004

Study shows new model of asthma care reduces kids’ symptoms

Seattle—A "planned-care method" of providing primary care for children with asthma can significantly reduce their symptoms and need for emergency medications, according to a study published in the September issue of Archives of Pediatrics and Adolescent Medicine. The method involves providing regularly scheduled visits with specially trained nurses to help families learn how to manage symptoms. In addition, physicians received extra education in asthma management.

"Our research shows that we can improve children’s asthma by doing a better job of organizing their routine care," said pediatrician Paula Lozano, MD, MPH, lead author of the study and a scientific investigator at Group Health Cooperative. "Pediatricians generally do a great job with well-child care, scheduling check-ups and shots at two weeks, two months, four months, and so on. This research shows the benefits of organizing care for chronic conditions like asthma in much the same way."

Using the planned-care method, nurses in the study had regularly scheduled calls and office visits to find out how the children were doing with their medications and self-management of symptoms. This information was conveyed to their children’s doctors. Then after the visits, the nurses met with families to set goals for better management, and to help families identify and solve problems that might be getting in the way of preventing symptoms.

After two years, the researchers found that, compared to children in usual care, the children in the planned-care practices:

• Had 13 fewer days of symptoms per year

• Needed a third less rescue medication

• Used their medication as prescribed, according to parents’ reports

"Our profession has developed some great evidence-based guidelines for asthma care and we know that if we follow them, children have improved outcomes," Lozano explained. "But the fact is, a busy primary care doctor cannot possibly provide all the guidance that’s needed. But if we reorganize our practice teams, we can do it."

How the study was conducted

Researchers followed 638 children ages 3 to 17 (average age 9.4 years) as they got care for more than two years. The researchers randomly assigned patients to one of three different groups, each one offering a different method for educating families and their doctors about asthma. The three methods were:

1. The "peer leader method," where one doctor from each practice gets special training and encourages other doctors in the practice to follow the guidelines.

2. The "planned-care method," where patients have regularly scheduled, planned visits with a specially trained asthma care nurse who assessed the kids’ day-to-day asthma control and shared her assessment with the primary care provider. She also helped families learn about the condition, how to manage symptoms, and how to prevent asthma from getting worse. In addition, the doctors in the practice follow the "peer leader method" described above.

3. Usual care

The study included children enrolled in Group Health Cooperative in Seattle, the Rush Prudential Health Plan in Chicago, and 16 practices in eastern Massachusetts—each affiliated with several insurers, including Harvard Pilgrim Health Care and Blue Cross Blue Shield of Massachusetts.

The study was funded by a four-year $6 million grant from the Agency for Healthcare Research and Quality, which is part of the federal Department of Health and Human Services, and the National Heart Lung and Blood Institute at the NIH. Kevin B. Weiss, MD, MPH, at the Hines VA Hospital and Northwestern University, Chicago, Illinois is the principal investigator. The study team is now analyzing the cost effectiveness of the planned-care model and hopes to publish these results soon. The cost-effectiveness analyses are being led by Sean Sullivan, PhD, at the University of Washington’s School of Pharmacy.

"We don’t have to invent expensive new technologies or drugs to make these improvements," said Lozano. "It’s just a matter of being more thoughtful about collecting information, sharing it with the doctor, and talking with the patient. These changes are eminently doable."

The Centers for Disease Control and Prevention estimates that asthma affects about 9 percent of all children. Most children with asthma get their treatment from primary care providers, Lozano explained.

In addition to Lozano, authors of the study are Jonathan A. Finkelstein, MD, MPH, Vincent J. Carey, PhD, Anne L. Fuhlbrigge, MD, MS, Stephen B. Soumerai, ScD, and Scott T. Weiss, MD, MS, of Harvard Medical School; Ed Wagner, MD, MPH, of Group Health Cooperative; Thomas S. Inui, MD, of Regenstreif Institution for Heath Care; Sean Sullivan, PhD, of the University of Washington; and Kevin B. Weiss, MD, of Hines VA Hospital and Northwestern University Feinberg School of Medicine.

How families and health care teams can work together

Group Health Cooperative researchers and their colleagues have discovered that when families and primary care teams work together in planning their asthma care, kids have better outcomes. Here are a few tips:

• Be open and honest with your child’s doctors and nurses. Share your thoughts, fears, and ideas about your child’s treatment. Tell them what’s working and what’s not working when it comes to medications and avoiding triggers. Then work together to find an approach that fits your family’s situation.

• Set goals together. Let your health care team know what you and your child would like to achieve. Examples might be sleeping though the night without coughing or playing basketball without wheezing. Ask your team what they can do to help.

• Get clear instructions. Asthma can be controlled by adjusting medications based on how severe the symptoms are. So be sure you understand your doctor’s instructions about medications. And ask for written instructions so you’ll have reminders for what to do later on.

• Keep appointments—even when your child’s asthma is under control. Don’t wait for a severe asthma attack before you talk to your doctor or nurse about your child’s health. Take opportunities during "well child" visits to ask questions and learn ways to prevent flare-ups or asthma emergencies.

About Group Health Center for Health Studies

Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants, the Center is located in Seattle, Washington. Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc. serve nearly 540,000 members in Washington and Idaho.

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