Asthma care reminders for clinicians improve patients’ use of preventive medication and reduce caregiver’s concerns about these medications, according to a new study. The findings will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C.
Researchers conducted a trial of 530 children with persistent or uncontrolled asthma at 18 pediatric and family medicine clinics in the Bronx, New York, to determine how the inclusion of clinician reminders about asthma severity and care guidelines in electronic health record systems (EHRs) impact care and outcomes. Half of clinics received asthma care reminders through EHRs, while a control group did not. Patients’ caregivers completed regular follow-up surveys about preventive medication use, asthma symptoms, and healthcare utilization.
The study found that patients of clinicians who received the reminders were more likely to use preventive medication for asthma and their caregivers had less concerns about these medications. Researchers noted there were no differences in asthma outcomes between patients in either group.
“Clinical guidelines can help reduce complications for people with asthma by as much as 70%, but the key is following them consistently,” said Marina Reznik, M.D., M.S., vice chair for clinical and community-based research at Albert Einstein College of Medicine, Children’s Hospital at Montefiore and presenting author. “It's clear that electronic reminders can provide clinicians with the tools they need to improve asthma care but additional support is needed for these children to reduce asthma morbidity.”
Study authors concluded systemically screening and prompting clinicians with virtual guideline reminders can improve care for urban children with asthma.
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EDITOR:
Dr. Reznik will present “Improved Preventive Asthma Care: A Cluster Randomized Controlled Trial (RCT) of Clinician Prompting in the Outpatient Setting” on Sunday, April 30 at 8:00 a.m. ET.
Reporters interested in an interview with Dr. Reznik should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.
About the Pediatric Academic Societies Meeting
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Abstract: Improved Preventive Asthma Care: A Cluster Randomized Controlled Trial (RCT) of Clinician Prompting in the Outpatient Setting
Presenting Author: Marina Reznik, M.D., M.S.
Organization
Albert Einstein College of Medicine, Children's Hospital at Montefiore
Topic
General Pediatrics: Primary Care/Prevention
Background
Use of asthma guidelines reduces morbidity; yet studies show poor clinician adherence to these guidelines. Clinician prompts can improve preventive care, but few studies have evaluated the effects of such prompts on asthma care and outcomes in real-world clinical setting.
Objective
To determine if clinician prompting on child’s asthma severity and guideline recommendations during an office visit effects preventive asthma care delivery and clinical outcomes.
Design/Methods
We conducted a cluster RCT at 18 pediatric and family practice clinics in the Bronx, NY (2017–2022). Clinics were randomized to a clinician-prompting group (a clinician prompt with guideline-based decision support built within Electronic Health Records (EHR) that appeared at the time of visit) or a control group (no prompt). Both groups had screening for asthma severity/level of control with questions assessing impairment and risk built within the EHR and administered by nursing staff. Patients (age 2-12 yrs) with persistent asthma were enrolled at the time of the visit and caregivers completed phone surveys at 3, 6, 9, and 12 months. Outcome measures included report of preventive medication use, asthma symptoms, healthcare utilization, and beliefs about medications (BMQ). We evaluated the intervention effect using generalized linear models with GEE method to account for repeated assessments.
Results
We enrolled 530 children (intervention N= 265, control N= 265, response rate 91%). Intervention and control group children had similar demographic characteristics and asthma symptoms at baseline (Table 1). After adjusting for seasonality, children in the intervention group had greater change in odds of preventive medication use compared to the control group at the 3, 9, and 12 month follow-ups [β = 0.38 (95% CI (0.05, 0.72), 0.49 (0.14, 0.84), 0.40 (0.00, 0.79), respectively; Table 2]. While there were no differences in asthma symptoms between groups, the change in the odds of any asthma related health care utilization was lower in the intervention group compared to the control group at the 12 month follow up [β = -0.53 (95%CI -1.03,-0.03)]. Caregivers in the intervention group also reported less concern about preventive medications at 3 months [β = -0.93; 95%CI (-1.66, -0.20)].
Conclusion(s)
Clinician prompting on asthma severity and care guidelines within the EHR at the time of a visit in busy clinical practices significantly improved preventive medication use and decreased healthcare utilization. Incorporating systematic screening and prompting into routine visits may improve care and reduce morbidity of urban children with asthma.
Tables and Images
