title: Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial.
abstract: BACKGROUND
  Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice.
  
  
  METHODS
  This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices. Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention.
  
  
  RESULTS
  Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms.
  
  
  CONCLUSIONS
  Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.
authors: Keenan Research Center, Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Canada. merrick.zwarenstein@ices.on.ca
authors: Merrick
authors: M
authors: Zwarenstein
authors: Angeni
authors: A
authors: Bheekie
authors: Carl
authors: C
authors: Lombard
authors: George
authors: G
authors: Swingler
authors: Rodney
authors: R
authors: Ehrlich
authors: Martin
authors: M
authors: Eccles
authors: Michael
authors: M
authors: Sladden
authors: Sandra
authors: S
authors: Pather
authors: Jeremy
authors: J
authors: Grimshaw
authors: Andrew D
authors: AD
authors: Oxman