Physician-education program improves asthma care and outcome


Investigators evaluated a previously developed and tested interactive seminar, the Physician Asthma Care Education (PACE) program, in 10 cities across the nation. In the five intervention cities (the other five were controls), researchers recruited a primary care pediatrician, pediatric subspecialist, and behavioral scientist-health educator to be the PACE faculty team in that area.

The five teams conducted training for study physicians in their community. The intervention consisted of interactive seminars to review asthma guidelines, specific communication techniques, and key asthma educational messages. Instructional methods included a standardized lecture on clinical practice guidelines, a video depicting effective clinician teaching and communication behavior, case studies presenting troublesome clinical problems, a protocol for patient communication self-assessment, examples of long-term asthma management plans, and a review of topics to cover and materials to use when teaching patients.

A total of 101 primary care providers (99 were pediatricians) participated in the trial. Each participant provided a registry of patients from 2 to 12 years of age with active asthma; 731 patients were followed for a year (a median of seven patients for each provider). Patients and their parents were blind to physicians' involvement in the intervention and physicians were blind to which of their patients were selected for the survey. All parents were interviewed by telephone at baseline and one year after the seminar to assess changes in asthma symptoms, their child's health-care utilization, and changes in physician communication and counseling behavior. To assess changes in physician practice and perceptions, physicians completed a self-administered survey before the educational intervention and 12 months after it was over.

Physicians in the intervention group reported that the PACE program increased their confidence in their ability in several areas: to perform certain skills related to encouraging patient self-management of asthma, to develop a short-term plan for asthma, and to review with patients the long-term plan for care (Cabana MD et al: Pediatrics 2006;117:2149).

Commentary These investigators looked carefully at whether new information, the result of research and expert-generated practice guidelines, can be moved to the front lines in office practice across the country. The study shows that not only is this goal feasible but that resulting patient outcomes will be measurable. Look for more studies that measure the effectiveness of continuing medical education programs.

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