Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control.
BACKGROUND
An acute-care visit for asthma often signals a management failure. Although a written action plan is effective when combined with self-management education and regular medical review, its independent value remains controversial.


OBJECTIVE
We examined the efficacy of providing a written action plan coupled with a prescription (WAP-P) to improve adherence to medications and other recommendations in a busy emergency department.


METHODS
We randomized 219 children aged 1-17 years to receive WAP-P (n = 109) or unformatted prescription (UP) (n = 110). All received fluticasone and albuterol inhalers, fitted with dose counters, to use at the discretion of the emergency physician. The main outcome was adherence to fluticasone (use/prescribed × 100%) over 28 days. Secondary outcomes included pharmacy dispensation of oral corticosteroids, β(2)-agonist use, medical follow-up, asthma education, acute-care visits, and control.


RESULTS
Although both groups showed a similar drop in adherence in the initial 14 days, adherence to fluticasone was significantly higher over Days 15-28 in children receiving WAP-P (mean group difference, 16.13% [2.09, 29.91]). More WAP-P than UP patients filled their oral corticosteroid prescription (relative risk, 1.31 [1.07, 1.60]) and were well-controlled at 28 days (1.39 [1.04, 1.86]). Compared with UP, use of WAP-P increased physicians' prescription of maintenance fluticasone (2.47 [1.53, 3.99]) and recommendation for medical follow-up (1.87 [1.48, 2.35]), without group differences in other outcomes.


CONCLUSIONS
Provision of a written action plan significantly increased patient adherence to inhaled and oral corticosteroids and asthma control and physicians' recommendation for maintenance fluticasone and medical follow-up, supporting its independent value in the acute-care setting. Clinical trial registered with www.clinicaltrials.gov (NCT 00381355).
Ducharme
Francine M
FM
Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca
Zemek
Roger L
RL
Chalut
Dominic
D
McGillivray
David
D
Noya
Francisco J D
FJ
Resendes
Sandy
S
Khomenko
Lyudmyla
L
Rouleau
Rachel
R
Zhang
Xun
X
D000293:Adolescent; D000305:Adrenal Cortex Hormones; D032722:Advance Care Planning / Q000458:organization & administration*; D000420:Albuterol / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D000068298:Fluticasone; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone; D000420:Albuterol