Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial

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dc.contributor.authorZwarenstein, Merricken_ZA
dc.contributor.authorBheekie, Angenien_ZA
dc.contributor.authorLombard, Carlen_ZA
dc.contributor.authorSwingler, Georgeen_ZA
dc.contributor.authorEhrlich, Rodneyen_ZA
dc.contributor.authorEccles, Martinen_ZA
dc.contributor.authorSladden, Michaelen_ZA
dc.contributor.authorPather, Sandraen_ZA
dc.contributor.authorGrimshaw, Jeremyen_ZA
dc.contributor.authorOxman, Andrewen_ZA
dc.date.accessioned2015-10-12T11:00:58Z
dc.date.available2015-10-12T11:00:58Z
dc.date.issued2007en_ZA
dc.description.abstractBACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.en_ZA
dc.identifier.apacitationZwarenstein, M., Bheekie, A., Lombard, C., Swingler, G., Ehrlich, R., Eccles, M., ... Oxman, A. (2007). Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial. <i>Implementation Science</i>, http://hdl.handle.net/11427/14210en_ZA
dc.identifier.chicagocitationZwarenstein, Merrick, Angeni Bheekie, Carl Lombard, George Swingler, Rodney Ehrlich, Martin Eccles, Michael Sladden, Sandra Pather, Jeremy Grimshaw, and Andrew Oxman "Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial." <i>Implementation Science</i> (2007) http://hdl.handle.net/11427/14210en_ZA
dc.identifier.citationZwarenstein, M., Bheekie, A., Lombard, C., Swingler, G., Ehrlich, R., Eccles, M., ... & Oxman, A. D. (2007). Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial. Implementation Science, 2(1), 30.en_ZA
dc.identifier.ris TY - Journal Article AU - Zwarenstein, Merrick AU - Bheekie, Angeni AU - Lombard, Carl AU - Swingler, George AU - Ehrlich, Rodney AU - Eccles, Martin AU - Sladden, Michael AU - Pather, Sandra AU - Grimshaw, Jeremy AU - Oxman, Andrew AB - BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting. DA - 2007 DB - OpenUCT DP - University of Cape Town J1 - Implementation Science LK - https://open.uct.ac.za PB - University of Cape Town PY - 2007 T1 - Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial TI - Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial UR - http://hdl.handle.net/11427/14210 ER - en_ZA
dc.identifier.uri10.1186/1748-5908-2-30en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14210
dc.identifier.vancouvercitationZwarenstein M, Bheekie A, Lombard C, Swingler G, Ehrlich R, Eccles M, et al. Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial. Implementation Science. 2007; http://hdl.handle.net/11427/14210.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceImplementation Scienceen_ZA
dc.source.urihttp://www.implementationscience.com/en_ZA
dc.subject.otherAsthmaen_ZA
dc.subject.otherMedicationen_ZA
dc.titleEducational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trialen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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