title: Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial.
abstract: OBJECTIVE
  A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care.
  
  
  OBJECTIVE
  To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma.
  
  
  METHODS
  Cluster randomized trial in which 12 urban primary care practices were matched based on size and type and randomly allocated to the PAIR-UP intervention or usual care (UC). We enrolled 638 children aged 2 to 12 years with persistent or poorly controlled asthma in the waiting room prior to a visit with a clinician for any reason from October 2009 to January 2013. Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit and called them 2 and 6 months later to assess symptoms.
  
  
  METHODS
  Children enrolled at PAIR-UP practices received prompts for the caregiver and clinician at the time of the visit that outlined the child's asthma severity or control as well as specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. The UC practices received copies of the asthma guidelines.
  
  
  METHODS
  The primary outcome was symptom-free days (SFDs) per 2 weeks at the 2-month follow-up.
  
  
  RESULTS
  We enrolled 638 children (participation rate of 80%; 36% were black, 36% were Hispanic, and 68% had Medicaid insurance). Groups were similar in demographic characteristics and asthma severity at baseline. At the index visit, more children in the PAIR-UP group received a preventive medication action (new medication, increased dose, recommendation to restart preventive medication) than in the UC group (58% vs 33%; odds ratio [OR] = 2.8; 95% CI, 1.9 to 3.9). More children in the PAIR-UP group than in the UC group received an asthma action plan (61% vs 23%; OR = 8.3; 95% CI, 3.7 to 18.7), discussions regarding asthma (93% vs 78%; OR = 4.5; 95% CI, 2.8 to 7.2), and secondhand smoke counseling (80% vs 63%; OR = 2.6; 95% CI, 1.2 to 5.5). At the 2-month follow-up, children in the PAIR-UP group had more SFDs per 2 weeks than those in the UC group (mean difference, 0.78 days; 95% CI, 0.29 to 1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference, 0.56; 95% CI, -0.14 to 1.25).
  
  
  CONCLUSIONS
  The PAIR-UP intervention improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma at 2 months, but the improvement in SFDs was no longer significant at 6 months.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01105754.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Jill S
authors.initials: JS
authors.lastname: Halterman
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Fagnano
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Tremblay
authors.affiliation: Department of Clinical Sciences, Temple University, Philadelphia, Pennsylvania.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Fisher
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Szilagyi
authors.affiliation: Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Arlene
authors.initials: A
authors.lastname: Butz
mesh_terms: D001249:Asthma / Q000517:prevention & control*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D016896:Treatment Outcome; D014504:Urban Health