Using the telephone to improve care in childhood asthma

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DESCRIPTION (Provided by Applicant): Asthma is the most common chronic disease of childhood and a major cause of morbidity in the United States. If asthma symptoms are controlled, a child with asthma can stay well and lead a normal life. Daily use of inhaled steroids controls symptoms and reduces morbidity and emergent health care utilization in children with persistent asthma, and is safe for long-term use. However, inhaled steroids are underutilized in community asthma care. Delivering effective preventive care for children with asthma in the community requires a change from a reaction orientation towards a proactive orientation for both parents and physicians. The parent must be actively involved in the child's asthma management. Structured self-management programs that include collaborative goal setting, self-management training and support, and active sustained follow-up, improve outcomes in patients with chronic diseases. Provider-initiated calls have been shown to be an effective way to deliver routine care and behavioral interventions to patients with chronic diseases, and have reduced morbidity and utilization of health services. Redesigning primary care to share the work of asthma care, and use the telephone to implement a self-management program for parents offers an efficient way to provide optimal asthma care for children in the community. Collaboration among experienced Washington University asthma researchers and the WU PAARC network of community pediatricians affords an opportunity to build on previous work and evaluate this approach in the primary care setting. The Telephone Asthma Program (TAP) comprises a series of brief, proactive telephone consultations with a trained nurse to augment the care provided by the child's pediatrician and facilitate self-management by the parent. The nurse will monitor symptoms, teach self-management skills, collaborate with the parent to increase effective use of inhaled steroids, provide support and remind the parent to go for follow-up care with the pediatrician. We hypothesize that the Telephone Asthma Program will reduce the incidence of acute exacerbations of asthma that require emergent care, improve the quality of life of children with asthma and their parents, and increase the daily use of inhaled steroids in children with persistent asthma. We will evaluate the Telephone Asthma Program in a randomized controlled trial involving 360 children aged 5 to 12 years old cared for by pediatrician members of WU PAARC in St Louis.