The influence of structured information and monitoring on the outcome of asthma treatment in primary care: a cluster randomized study.
BACKGROUND
In clinical trials of asthma, the outcomes are often good, but when the same treatment regimens are implemented in primary care, equally good results are not obtained.


OBJECTIVE
To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control.


METHODS
141 patients from 19 primary care centres were studied. The centres were randomised to a standard care group or to an intervention group. The intervention group received structured written and oral information about asthma and asthma medication, and were instructed to keep an asthma diary. The primary outcome was asthma control as assessed by the Asthma Control Questionnaire. Secondary outcomes were costs of asthma medication, the Mini Asthma Quality of Life Questionnaire score and lung function.


RESULTS
Asthma Control Questionnaire score changes differed between the study groups (p < 0.05). In the intervention group, these changes (M = -0.45) in asthma control were close to clinical significance (minimal important difference approximately 0.5). Both groups improved in disease-specific quality of life scores. For the intervention group, which changed the most (p < 0.05), the change exceeded the threshold for the minimal important difference (0.5). The costs of medications increased significantly in the intervention group, where adjustments of medication were made more often than in controls.


CONCLUSIONS
Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to standard care.
Nokela
Mika
M
Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. mika.nokela@ki.se
Arnlind
Marianne Heibert
MH
Ehrs
Per-Olof
PO
Krakau
Ingvar
I
Forslund
Lennart
L
Jonsson
Eva Wikström
EW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
D018927:Anti-Asthmatic Agents