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Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial

机译:对全科医生的教育推广减少了儿童的哮喘症状:一项整群随机对照试验

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摘要

BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.
机译:背景:儿童哮喘在南非的开普敦很常见,但全科医生对此诊断不足。药物经常被不适当地开出处方,并且护理是短暂的。这项研究的目的是评估对全科医生的教育宣传对他们实践中儿童哮喘症状的影响。方法:这是一项以一般实践为干预,随机化和分析单位的整群随机试验。地点是开普敦附近的宿舍城镇米切尔平原(人口30万)。在没有护士支持的情况下,单身全科医生从店面工作。收集了318名符合条件的儿童(2至17岁)的中度至重度哮喘的照护者报告的症状数据,这些儿童在Mitchells Plain接受全科医生治疗。在所有43种实践中收集了这些儿童中271名(85%)的干预后一年的随访数据。干预的随机方法(21)由一名训练有素的药剂师进行了两次30分钟的教育外访,他们留下了描述关键干预措施的材料改善哮喘护理。干预和控制措施获得了国家儿童哮喘指南。哮喘的严重程度是在家长完成的一项调查中测量的,该调查是通过学校使用症状发生频率和严重程度量表进行的。我们比较了干预组和对照组儿童从干预前到干预后一年的得分变化。结果:与对照组相比,干预组的症状评分又下降了0.84分(9分制,p = 0.03)。每分配给一名干预措施的医生,每12名哮喘患儿中,多一名儿童的症状就会大大减轻。结论:教育宣传已被全科医生接受并有效。在这种情况下,它可以应用于其他医疗保健质量问题。

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