Improved preventive care for asthma: a randomized trial of clinician prompting in pediatric offices.
OBJECTIVE
To determine whether clinician prompting regarding a child's symptom severity and guideline recommendations at the time of an office visit improves the delivery of preventive asthma care.


METHODS
Randomized controlled trial.


METHODS
Two inner-city pediatric practices in Rochester, NY.


METHODS
Two hundred twenty-six children with persistent asthma (aged 2-12 years) presenting to the clinics for well-child care, asthma care, or non-asthma-related illness care. Intervention We assigned children randomly to a clinician-prompting group (single-page prompt including the child's symptoms and guideline recommendations given to the clinician at the time of the visit) or a standard-care group (no prompt given). Interviewers called parents after the visit to inquire about preventive measures taken, and medical charts were reviewed.


METHODS
Any preventive action related to asthma taken at the visit.


RESULTS
Children in the clinician-prompting group were more likely to have had any preventive measures taken at the visit compared with children in the standard-care group (87% vs 69%). Specifically, visits for children in the clinician-prompting group were more likely to include delivery of an action plan (50% vs 24%), discussions regarding asthma (87% vs 76%), and recommendations for an asthma follow-up visit (54% vs 37%). In a regression model, children in the clinician-prompting group had 3-fold greater odds of receiving any preventive action compared with the standard-care group.


CONCLUSIONS
Clinician prompting regarding asthma severity and care guidelines at the time of an office visit significantly improved the delivery of preventive asthma care.
Halterman
Jill S
JS
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Fisher
Susan
S
Conn
Kelly M
KM
Fagnano
Maria
M
Lynch
Kathleen
K
Marky
Andrew
A
Szilagyi
Peter G
PG
D001249:Asthma / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic