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Bravata DM, Sundaram V, Lewis R, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jan. (Technical Reviews, No. 9.5.)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care).
Show detailsTable 23Summary of provider education interventions for the improvement of asthma in general populations or adults
| Reference | Study Purpose | Target population | Study Design | Type of intervention | Results |
|---|---|---|---|---|---|
| Cordina et al.159 | To examine the effects of a community pharmacy-based education and monitoring program for patients with asthma on a range of patient-specific asthma management outcomes. | 152 patients over the age of 14 who received their asthma prescriptions at private pharmacies in Malta. | CBA | A comprehensive asthma education and monitoring program was instituted in private pharmacies in Malta for 12 months. The intervention pharmacists reviewed patients asthma symptoms, PF records, medication use, and when necessary suggested changes in treatment to the patient's physician. | There was no significant difference between treatment and control groups in terms of PF measurement, self-reported inhaler use, days lost from work or school, or health related QOL. There were fewer self-reported hospitalizations for asthma among intervention patients (0/86) than among control patients (8/66) (p<0.002) but no other differences in health services utilization. The intervention patients were less likely to report nighttime wheezing and more likely to improve their inhaler technique than control patients. 159 |
| Daniels et al.236 | To assess the effectiveness of an intervention designed to increase compliance with national asthma care guidelines in primary care safety net health centers serving high-disparity patient populations | 16 federally-funded community health centers in eight southeastern states in the U.S. Ncon=9, Nint=7. | RCT | The intervention consisted of three components: resources (asthma kits including PF meter, MDI spacer device, educational materials) which clinicians were encouraged to give to patients, training of all health center staff in asthma care guidelines which emphasized the need for patients to have Management, action, and prevention plans, and tools or templates for practice-level systems change (asthma flow sheets and standing orders). Control group sites received copies of the national asthma guidelines and one asthma resource kit with information on how they could obtain more at a discounted price. | There were no significant differences between the intervention and control sites in the number of patients who had been instructed how to use and MDI or a PF meter, counseled regarding environmental triggers, been given a written action plan, counseled on maintenance and rescue plans, or prescribed steroids or anti-inflammatory inhalers. There was a significant increase in the intervention group compared to the control in the number of patients who had their PF measured and recorded in clinic (p=0.006) and documenting interval symptom history (p=0.008).236 |
| Feifer et al.171 | To determine whether a population-based asthma disease management program, using broad-based educational interventions can have favorable effects on physician and patient adherence to guidelines-based care. | 70,900 patients with asthma patients aged 5–45 years using a specific prescription benefit plan in the U.S. 35,450 patients were in each group. | CBA | During the 12-months following enrollment, intervention patients and their physicians received educational materials. Patients in the intervention group received five workbooks and two newsletters. Educational materials emphasized guideline-based elements of asthma pharmacotherapy, self-management techniques, and trigger avoidance. Additionally, patients received refill reminders, prospective compliance reminders, and pollen count alerts by mail. Physicians received asthma management flow sheets to facilitate the tracking and review of patients' therapy. Patients in the control group received no educational materials, nor did their health-care providers. | All outcomes were measured as the change between baseline and 12 months after enrollment. The percentage of patients using controller therapy decreased less in the intervention group (p<0.0001), controller prescription refill rate increased in the intervention group (p<0.0001), and reliever prescription refills were reduced in the intervention group (p<0.001) compared to the control group.171 |
| Gorton et al.237 | To evaluate the effect of three different methods of disseminating asthma guidelines on physicians' behavior and attitudes toward education strategies | 76 primary care physicians in four Area Health Education Centers (AHECs) at the University of Arkansas for Medical Sciences. A total of 375 patient records were reviewed. Ncon=17, NA=11, NB=17, NC=18. | CBA | The study had 1 control group and 3 intervention groups. All intervention groups received the executive summary of the asthma guidelines produced by the National Institutes of Health (NIH). Physicians in Group A also received a 10-page summary of the guidelines, 2 telephone calls from “academic detailing” peer physicians, and were invited to attend a half-day continuing medical education (CME) conference. Physicians in Group B completed 4 computer-based modules, a computer conference with a moderator to discuss the guidelines. Physicians in Group C received a videocassette created for cable medical television, 4 facsimile messages in the hospital mailbox (weekly, for 4 weeks), and 4 posters were displayed in prominent locations in the hospital (monthly, for 4 months). Group C was also invited to the CME conference and received an audiocassette of the conference. Physicians in the control group received educational materials after the completion of the project. | After 4 months, both Group B and Group C physicians increased the appropriate use of oral β-agonists significantly more than control physicians (p=0.03 for both comparisons). Group C physicians increased the ordering of home PF monitoring more than control physicians (p=0.01). Groups A and B physicians increased PF monitoring at the office more than control physicians (p<0.05 and p<0.01, respectively). There were no differences among the groups in terms of improving the use of spirometry or symptom diaries, which remained low. There was also no significant difference in the use of any other asthma medication among the groups.237 |
| Lagerløv et al.230 | To evaluate the effects of a newly developed form of group education for improving the quality of prescribing in primary health care. | 190 GPs responsible for the care of asthma patients in Norway. | CBA | Like the control group, the intervention group participated in 2 group meetings—during one they discussed asthma diagnosis, and the key information for making treatment decisions. At the second meeting international and national guidelines for treating asthma were presented. The group then agreed on common quality criteria for what they found to be acceptable and unacceptable prescribing practices. Feedback on their prescription behaviors was given relative to the agreed upon quality criteria. | There was no difference in the number of patients treated by intervention providers with “acceptable medications” (p=0.18).230 |
| Lundborg et al.231 | To develop, implement, and evaluate a new educational model, with messages based on available national guidelines aimed at improving prescribing in primary care. | 204 GPs responsible for the care of asthma patients in Sweden. | CBA | GPs were asked to attend 2 group sessions. During the 1st session, individual feedback on written simulated cases was given and discussed. During the 2nd session, feedback on individual prescribing was presented and discussed. GPs were expected to: start/increase inhaled corticosteroids when bronchodilator use is too high; treat asthma exacerbations with anti-inflammatory treatment and not routinely with antibiotics; and 3) not start long-acting β2-agonists when the patient is on a sub-optimal level of inhaled corticosteroids. | Both the intervention and control groups had increases in the prescription of inhaled corticosteroids.231 |
| Rossiter et al.232 | To determine the potential of a disease management program in terms of improving the health of low-income Medicaid patients while achieving cost savings in providing treatment. | Virginia Medicaid population with moderate to severe asthma (a designation based on assessment of claims) who received care in a primary-care case management program (fee-for-service and HMO-based practices were excluded). | See note§ | Providers in primary-case-management programs with asthma patients were identified, and those who volunteered received an education workshop to improve communication skills and to inform them about current asthma treatment recommendations. Additionally, most participants also received intermittent feedback regarding who among their patients might benefit from further asthma education and treatment. | The intervention group had improved prescribing practices for β-agonists, but not for inhaled corticosteroids. The program had a significant effect on emergency visits, but only in the short-term post-intervention. This benefit was greater among those Medicaid claimants whose providers received feedback in addition to the educational workshop. The projected direct cost savings of the program is $3–4 for every incremental dollar spent. 232 |
| Tomson et al.238 | To assess the effects of a provider education program on prescribing practices and physician and patient knowledge of asthma. | General practitioners practicing in primary care clinics of Stockholm County (Sweden) (of whom 44 practicing in a similar region were assigned to the intervention group and 19 in a different region were assigned to the control group). | CBA* | A clinical pharmacologist and pharmacist visited the intervention practices and met with physicians in groups to discuss the treatment of asthma and to provide written information encouraging the use of inhaled glucocorticoids for prophylaxis, the use of PF meters, and testing to distinguish patients with COPD and asthma. | Significantly more providers in the intervention group reported recommending the use of PF meters and advised their patients in its use. There was no significant difference in prescribing practices.238 |
| Veninga et al.229 | To evaluate the effects of a newly developed form of group education for improving the quality of prescribing in primary health care. | 181 general practitioners (GPs) responsible for the care of asthma patients in the Netherlands. | CBA | Intervention providers received group education on asthma prescribing and performed a self-learning audit program for peer groups. During 2 meetings, groups met with a moderator with individual feedback material for all members of the groups; anonymity was not maintained by mutual agreement; use of case vignettes which the GPs had received by mail prior to the meetings; individualized feedback on prescribing provided at second meeting. | Increased use of inhaled corticosteroids was found in the intervention group.229 |
| Weng194 | To evaluate the effects of a government sponsored QI intervention with patient and provider education and case management services for patients with asthma. | 1067 patients with asthma enrolled in the program sponsored by the Taiwanese government. 4,340 patients with asthma who did not enroll in the program served as matched controls. | CBA | Providers received a 6-hour asthma curriculum that included conducting pulmonary function testing, use of medications and PF monitoring, environmental controls, and asthma pathophysiology. They were given copies of asthma clinical practice guidelines. Patients received individualized, personally tailored asthma education on recognizing triggers and symptoms, medication use, PF use, and self-management of exacerbations. Case managers (nurses or physician assistants) provided communication between patients, primary care physicians and specialists, and scheduled quarterly follow up. | 1 year after enrollment, the intervention group had longer hospital stays (by 40%, p=0.045) but no difference from control patients in the number of ED visits or number of hospitalizations. However, among patients newly diagnosed with asthma during the study interval, there was a decrease in ED visits (by 61%) in the intervention group compared to the controls.194 |
- *
CBA=controlled before-after trials
- §
The intervention group for this study was selected from providers in specified geographic areas. Medicaid claims were compared between the intervention area and non-intervention areas. Comparisons were made over time (ITS-like, with only two “before” measures but with explanation that analysis of a longer pre-intervention period yielded little change in variables) and between groups. Note: ED=emergency department; PF=peak flow; QOL=quality of life.
- Table 23, Summary of provider education interventions for the improvement of ast...Table 23, Summary of provider education interventions for the improvement of asthma in general populations or adults - Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care)
- Tssr106184 AND (alive[prop]) (0)Gene
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