PURPOSE OF THE STUDY.
National Asthma Education and Prevention Program (NAEPP) guidelines have been widely disseminated, but their adoption by primary care clinicians has been problematic. This study evaluated an asthma-management program based on NAEPP guidelines.
Children aged 6 months or older in Connecticut were enrolled in community pediatric offices by trained community personnel.
Pediatric office health care providers and personnel in 6 Connecticut communities were trained in an asthma-management program entitled “Easy Breathing,” which was based on NAEPP guidelines. Quality parameters encompassed enrollment census, relevant use of anti-inflammatory medications, and provision of a written action plan. Utilization of medical services was confirmed for Medicaid-covered children and compared by using relative rates and 95% confidence intervals (CIs) before and after enrollment.
There were 51 practices and 297 health care providers who enrolled 32 680 children from 2002 to 2007; 10 467 of these children had asthma according to history, 4354 of whom were insured by Medicaid. Children with persistent asthma according to history had a decline in the number of hospitalizations (relative rate: 0.51 [95% CI: 0.39–0.65]) and emergency department encounters (relative rate: 0.70 [95% CI: 0.68–0.84]) but no decline in the number of outpatient visits (relative rate: 0.99 [95% CI: 0.9–1.10]). The use of inhaled corticosteroids doubled with an increment in relevant utilization of anti-inflammatory medications to 96%, and a written action plan was provided to 94% of enrolled children with asthma.
The authors concluded that general pediatricians can effectively institute an asthma-management program, using NAEPP guidelines, that enhances asthma care for a large population of children.
The limitations of this study that affect its generalizability were (1) claims data were only available for Medicaid-insured children, (2) the intermittent character of state funding, and (3) the fact that both the number of outpatient visits and the filled-prescription rate were low. Therefore, the actual number of children who both filled prescriptions and received them is unknown. However, these results indicate that a disease-management program for pediatric asthma can be implemented successfully in a community pediatric setting with a subsequent significant decrease in the number of hospitalizations and emergency department visits in a large Medicaid-insured population of children.
- Copyright © 2011 by the American Academy of Pediatrics