Asthma Management Support Training in Pediatrics

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DESCRIPTION (provided by applicant): Pediatric self-management support interventions have lagged behind those for adults. Collaborative management requires that providers appreciate the challenges of behavior change and acknowledge patients' readiness to change, while enhancing self-efficacy. The aims of this Exploratory/Developmental R21 are (1) to evaluate the feasibility and acceptability of an intervention to enhance collaborative management by pediatrics residents and families of children with asthma, (2) to estimate the effect size on resident skill and patient-centered outcomes, and (3) to evaluate reliability of the objective standardized clinical examinations (OSCEs) used to assess resident skill. We will conduct a pilot RCT of the Collaborative Management in Pediatrics (CMP), a curriculum for training residents in behavior change techniques for collaborative management of children with asthma and their families. CMP is a pediatric adaptation of Brief Negotiation, an approach based on Motivational Interviewing developed by Kaiser Permanente. We will consent, recruit and randomize 20 first year pediatrics residents. Intervention residents will receive CMP training (two 3-hr sessions) and control residents will learn traditional asthma patient education. OSCEs with standardized patients will evaluate resident skill before and after training, and 6 months later. We will recruit 5-10 children aged 2-12 y with persistent asthma from the clinic panels of each resident. After informed consent and screening, parent report of process and outcome measures (e.g. symptom days, controller adherence, use of written care plan, tobacco avoidance, other self-care behaviors and satisfaction) will be obtained by phone survey. The survey will be repeated at 6 wks and 3 m. Baseline and 3 m hair samples will be assayed for nicotine to determine tobacco smoke exposure. Patients of intervention residents will be scheduled for a planned asthma care visit to focus on health behaviors, and a phone call one week later to follow-up on behavior change goals. Patients of control residents will be scheduled for an asthma education visit. The proposed activities will yield data to inform design and implementation of a full-scale effectiveness RCT. We hypothesize that CMP will be feasible, acceptable and lead to clinically significant improvements in resident counseling skills and patient-centered outcomes. In addition, this novel project will advance the field by providing tools for training pediatricians in collaborative management.