Prompting Asthma Intervention in Rochester–Uniting Parents and Providers (PAIR-UP)

Abstract

Importance disproportionate number of impoverished and minority children suffer from asthma and receive suboptimal preventive care. Objective To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma. Design Cluster randomized trial. Setting Twelve urban primary care practices in Rochester, NY, matched based on size/type and randomly allocated to ‘PAIR-UP’' or 'usual care (UC)'. Participants Children (2–12yrs) with persistent or poorly controlled asthma, enrolled in the waiting room prior to a visit with a provider for any reason. Interventions Children enrolled at PAIR-UP practices received prompts for the caregiver and healthcare provider at the time of the visit, which outlined the child's asthma severity/control and specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. UC practices received copies of the asthma guidelines. Main Outcomes and Measures Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit, and 2 and 6 months later to assess symptoms. The primary outcome was symptom-free days (SFDs)/2 week sat the 2-month follow-up. We used Weighted Generalized Estimating Equation to estimate the intervention effect, adjusting for clustering and confounding variables. Results We enrolled 638 children (participation rate:80%, 36% Black, 36% Hispanic, 68% Medicaid). Groups were similar in demographics and asthma severity at baseline. At the time of the visit, more children in PAIR-UP received a preventive medication action (new medication or increased dose) compared to UC (58%vs.33%; OR:2.8, 95%CI;1.9,3.9). Further, more PAIR-UP children received an asthma action plan (61%vs.23%; OR:8.3, 95%CI;3.7,18.7), discussions regarding asthma (93%vs.78%; OR:4.5, 95%CI;2.8,7.2), and secondhand smoke counseling (80%vs.63%; OR:2.6, 95%CI;1.2,5.5). At the 2 month follow-up, children in PAIR-UP had more SFDs/2 weeks compared to UC (mean difference 0.78 days, 95%CI;0.29,1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference 0.56, 95%CI;–0.14,1.25). Conclusions and Relevance PAIR-UP improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma.

Mycoplasma pneumoniae and health outcomes in children with asthma

“…Other studies have noted improvement in asthma symptoms over time in children with asthma, even without intervention. 18,19 (See eFigure 2 for histograms of outcome variables. )…”

Caregiver education to promote appropriate use of preventive asthma medications: what is happening in primary care?

“…The Prompting Asthma Intervention in Rochester - Uniting Parents and Providers (PAIR-UP) trial is a recently completed randomized study conducted in 12 urban primary care offices in Rochester, NY (31) . Each practice was randomly assigned to be a treatment site or usual-care site, with matching for size and patient demographics.…”

Non-drug treatments and rehabilitation of patients with bronchial asthma

“…However, it does not seem possible to identify the most effective therapeutic training programs for patients among more than 20 programs. Telemedicine training, written diaries for asthma self-monitoring (WAP) also reduce the risk of hospitalization, especially for patients with severe asthma [121,122,123], the best effect is achieved with multifaceted (combined) educational methods in primary care [124,125].…”