disproportionate number of impoverished and minority children suffer from asthma and receive suboptimal preventive care.
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.
Cluster randomized trial.
Twelve urban primary care practices in Rochester, NY, matched based on size/type and randomly allocated to ‘PAIR-UP’' or 'usual care (UC)'.
Children (2–12yrs) with persistent or poorly controlled asthma, enrolled in the waiting room prior to a visit with a provider for any reason.
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.
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.