Educational outreach to general practitioners reduces children’s asthma symptoms: a cluster randomised controlled trial
Open accessAbstract
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.
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In Zwarenstein 2007, the risk of reporting bias was judged unclear because there was no information on adherence to recommended practice.
“Selective reporting (reporting bias) Unclear risk No information on adherence to recommended practice”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the overall risk of bias was judged unclear because 2 criteria were at unclear risk.
“Risk of bias overall Unclear risk 2 criteria unclear risk”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of detection bias was judged low because data were based on a patient-completed questionnaire.
“Blinding of outcome assessment (detection bias) All outcomes Low risk Symptom questionnaire completed by patients”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of selection bias from random sequence generation was judged low because a computer-generated list of random numbers was used.
“Random sequence generation (selection bias) Low risk Quote:”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of contamination bias was judged low because randomisation was at general practice level.
“Contamination Low risk Randomised at general practice level”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of bias from baseline characteristics was judged low because baseline characteristics were comparable.
“Baseline characteristics Low risk Baseline characteristics comparable”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of attrition bias was judged low because over 84% of patients in each study group provided data.
“Incomplete outcome data (attrition bias) All outcomes Low risk Over 84% of patients in each study group provided data”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of other bias was judged low because practitioners and patients were generally similar and randomisation by practice reduced the risk of contamination.
“Other bias Low risk Generally similar practitioners and patients in study and control groups; randomised by practice, reducing the risk of contamination”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of performance bias was judged low because data were based on a questionnaire completed by patients.
“Blinding of participants and personnel (performance bias) All outcomes Low risk Data were based on a questionnaire completed by patients”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of selection bias from allocation concealment was judged unclear because the method of allocation was not described.
“Allocation concealment (selection bias) Unclear risk Method of allocation not described”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
In Zwarenstein 2007, the risk of bias from baseline outcomes was judged low because baseline outcomes were similar.
“Baseline outcomes Low risk Baseline outcomes similar”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Zwarenstein 2007
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- Authors
- Zwarenstein, M., Bheekie, A., Lombard, C., Swingler, G., Ehrlich, R., Eccles, M., Sladden, M., Pather, S., Grimshaw, J., & Oxman, A. D.
- Affiliations
- St. Michael's Hospital (CA)
- University of the Western Cape (ZA)
- South African Medical Research Council (ZA)
- University of Cape Town (ZA)
- Newcastle University (GB)
- Leicester Royal Infirmary (GB)
- University of Ottawa (CA)
- Corresponding author
- Zwarenstein, Merrick
- ORCID
- Venue
- Implementation Science
- Published
- 2007-09-24
- Volume
- 2
- Issue
- 1
- Pages
- 30-30
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC2200659
- OpenAlex
- W2100864378
- Cited by
- 22
- References
- 17
- Citations by year
- 2026: 1 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 2 · 2012: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
- TSpace (University of Toronto) (submittedVersion, public-domain)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- GlaxoSmithKline
- European Commission
- University of Cape Town
- Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- childhood asthma, educational outreach, general practitioners, pharmacist outreach, asthma symptom severity, asthma care quality, underdiagnosis, drug prescribing, asthma guidelines, primary care, Cape Town
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