title: Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up.
abstract: OBJECTIVE
  For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner (GP) or paediatrician.
  
  
  METHODS
  Randomised controlled trial evaluating standard care by a GP, paediatrician or an asthma nurse, with two-year follow-up.
  
  
  RESULTS
  107 children were recruited, 45 from general practice and 62 from hospital. After two years, no significant differences between groups were found for airway responsiveness, FEV1, asthma control, medication, school absence or parental work absence. In the general practice group there was a significantly lower frequency of regular review visits ('regular' = at least one review per six months) compared to the paediatrician and specialised asthma nurse group, both after one year [45.7% versus 87.9% and 94.3%, respectively, (p<0.0005)] and after two years [26.5% versus 87.9% and 75.8%, respectively, (p<0.0005)]. We found no significant differences in unplanned visits. In most cases the asthma nurse was able to provide care without consultation with the paediatrician.
  
  
  CONCLUSIONS
  The degree of disease control in stable childhood asthma managed by an asthma nurse is not inferior to traditional management by primary or secondary care physicians. The results also suggest that a lower review frequency does not detract from good disease control.
authors.affiliation: Department of Paediatrics, Amphia Hospital, Breda, Noord Brabant, The Netherlands. mkuethe@amphia.nl
authors.forename: Maarten
authors.initials: M
authors.lastname: Kuethe
authors.forename: Anja
authors.initials: A
authors.lastname: Vaessen-Verberne
authors.forename: Paul
authors.initials: P
authors.lastname: Mulder
authors.forename: Patrick
authors.initials: P
authors.lastname: Bindels
authors.forename: Wim
authors.initials: W
authors.lastname: van Aalderen
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000553:Ambulatory Care / Q000379:methods*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000458:organization & administration; D006801:Humans; D008297:Male; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D059039:Standard of Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents