Do small group workshops and locally adapted guidelines improve asthma patients' health outcomes? A cluster randomized controlled trial

Abstract

Objective. To improve health outcomes of children and adolescents with asthma using a multifaceted intervention for GPs. Methods. The design of the study was a cluster randomized controlled trial. GPs were randomized at a practice level in general practice clinics in Melbourne, Australia. Participants were children/adolescents aged 2–14 years with asthma and their caregivers identified from the medical records of participating clinics. Questionnaires were completed by 411 at baseline and 341 at follow-up. The intervention arm (n = 18 GPs) participated in a small group asthma education programme and was provided with locally adapted paediatric asthma guidelines. One control arm (n = 18 GPs) received only the adapted paediatric asthma guidelines, while the other control arm (n = 15 GPs) received an unrelated educational intervention. The outcome measures of the study were children/adolescents and caregivers completed questionnaires about asthma management and control, asthma knowledge and quality of life at recruitment and 6 months later. Ownership of a written asthma action plan (WAAP) was the primary outcome. Results. There was no evidence for changes in ownership of WAAPs between the three study arms. Adolescents in the intervention group reported an improvement in quality of life subscale score ‘positive effects’ (mean difference = 2.64, P = 0.01), but there was no evidence for an effect of the intervention on other study outcomes among the three study arms. Conclusions. The intervention was associated with some improvement in quality of life for adolescents. However, overall, the intervention did not translate into increased ownership of WAAPs, control of asthma or improved quality of life.