title: Effectiveness of a multi-level asthma intervention in increasing controller medication use: a randomized control trial.
abstract: BACKGROUND
  Poor self-management by families is an important factor in explaining high rates of asthma morbidity in Puerto Rico, and for this reason we previously tested a family intervention called CALMA that was found effective in improving most asthma outcomes, but not effective in increasing the use of controller medications. CALMA-plus was developed to address this issue by adding to CALMA, components of provider training and screening for asthma in clinics.
  
  
  METHODS
  Study participants were selected from claims Medicaid data in San Juan, Puerto Rico. After screening, 404 children in eight clinics were selected after forming pairs of clinics and randomizing the clinics) to CALMA-only or CALMA-plus.
  
  
  RESULTS
  For all three primary outcomes at 12 months, the mean differences between treatment arms were small but in the predicted direction. However, after adjusting for clinic variation, the study failed to demonstrate that the CALMA-plus intervention was more efficacious than the CALMA-only intervention for increasing controller medication use, or decreasing asthma symptoms. Both groups had lower rates of asthma symptoms and service utilization, consistent with previous results of the CALMA-only intervention.
  
  
  CONCLUSIONS
  Compliance of providers with the intervention and training, small number of clinics available and the multiple barriers experienced by providers for medicating may have been related to the lack of difference observed between the groups. Future interventions should respond to the limitations of the present study design and provide more resources to providers that will increase provider participation in training and implementation of the intervention.
authors.affiliation: a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico .
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.affiliation: b Department of Psychology , New York University , New York , NY , USA , and.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Shrout
authors.affiliation: a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico .
authors.forename: Doryliz
authors.initials: D
authors.lastname: Vila
authors.affiliation: a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico .
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramírez
authors.affiliation: c The Johns Hopkins School of Medicine , Baltimore , MD , USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
mesh_terms: D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D008484:Medicaid; D009726:Nurses; D010353:Patient Education as Topic / Q000458:organization & administration; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration*; D011647:Puerto Rico; D012648:Self Care / Q000379:methods*; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Asthma medication intervention; Latinos; randomized control trial