title: Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?
abstract: BACKGROUND
  Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.
  
  
  OBJECTIVE
  To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.
  
  
  METHODS
  A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.
  
  
  RESULTS
  Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001).
  
  
  CONCLUSIONS
  Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).
authors: 1 Department of Pediatrics and.
authors: Beverley J
authors: BJ
authors: Sheares
authors: 1 Department of Pediatrics and.
authors: Robert B
authors: RB
authors: Mellins
authors: 2 Department of Medicine, College of Physicians and Surgeons, and.
authors: Emily
authors: E
authors: Dimango
authors: 3 Albert Einstein College of Medicine, Bronx, New York.
authors: Denise
authors: D
authors: Serebrisky
authors: 4 Department of Biostatistics and.
authors: Yuan
authors: Y
authors: Zhang
authors: 1 Department of Pediatrics and.
authors: Michael R
authors: MR
authors: Bye
authors: 5 Weill Cornell Medical College, New York, New York; and.
authors: Mark E
authors: ME
authors: Dovey
authors: 6 Department of Medicine and.
authors: Sami
authors: S
authors: Nachman
authors: 7 Department of Pediatrics, Harlem Hospital Center, New York, New York.
authors: Vincent
authors: V
authors: Hutchinson
authors: 1 Department of Pediatrics and.|8 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors: David
authors: D
authors: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D010349:Patient Compliance; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D013038:Specialization; D014505:Urban Population; D055815:Young Adult
keywords: action plans; asthma; minority; physicians; self-management