EFFICACY OF WRITTEN TREATMENT PLANS IN ASTHMA

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DESCRIPTION (provided by applicant): Effective self-management of asthma requires that patients or their caregivers recognize the early symptoms of an exacerbation and initiate appropriate interventions aimed at preventing the progression of symptoms. Most asthma clinical guidelines suggest that the incorporation of a written self-management plan is an essential tool that patients must possess, be able to understand, and follow if they are to respond appropriately to changes in asthma status. Nevertheless, there are no controlled trials examining the efficacy of the written plan itself. Furthermore, even if written plans are an essential and an effective component of successful self-management, the data suggest that few patients receive them. Barriers to the use of written plans need more study if patients and physicians are to increase their use of this tool. Additionally, studies are needed to examine the efficacy of written plans across different patient populations. The overall goal of this study is to assess the efficacy of a model, written treatment plan in a randomized, controlled trial (RCT) compared with the usual care that is provided by a group of adult and pediatric pulmonologists and allergists in their practice settings. The model plan is a form that allows a treatment regimen consistent with NHLBI guidelines to be conveyed to patients. An additional goal is to assess how patients from different racial/ethnic backgrounds utilize treatments plans. Specific aims: 1) to identify barriers to the use of written plans and determine whether these barriers differ across racial/ethnic groups; 2) to develop, validate, and pilot test a model written treatment plan form plus instructions to doctors for its use; and 3) to conduct a RCT of the model plan form with African-American, Latino, and non-Latino white patients to: a) assess the efficacy of the plan across patient populations and b) determine if using written plans reduce racial/ethnic disparities in asthma outcomes. We hypothesize that patients with asthma who receive the model written plan form will have, relative to patients in the control group, significantly greater improvement in 3 primary outcome measures: 1.1) reduction in asthma symptom frequency; 1.2) reduction in emergency use of health care services; and 1.3) improved quality of life. We will also examine 4 secondary outcome measures: 1.4) asthma hospitalizations; 1.5) days with activity restriction; 1.6) the proportion of patients in the intervention group who receive the plan during the initial visit; and 1.7) use of the plans by patients.