Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial.
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.
Zwarenstein
Merrick
M
Keenan Research Center, Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Canada. merrick.zwarenstein@ices.on.ca
Bheekie
Angeni
A
Lombard
Carl
C
Swingler
George
G
Ehrlich
Rodney
R
Eccles
Martin
M
Sladden
Michael
M
Pather
Sandra
S
Grimshaw
Jeremy
J
Oxman
Andrew D
AD