Many children with asthma suffer from frequent symptoms and limitations in their activities, necessitating numerous visits to the emergency room. Many pediatricians do not contact families periodically to check on asthma control, identify concerns or management issues, or provide self-management instruction. Effective asthma care interventions like small group training and care redesign have been challenging to implement in office practice. A protocol for a 12-month telephone-coaching program aimed to enhance primary care management of children with persistent asthma and, as a result, improve asthma control and disease-related quality of life while reducing asthma-related urgent care occurrences is described in this work. Eligible families were randomly assigned to either the coaching program or routine care at the practice level. The transtheoretical model of behavior change was used to guide the coaching intervention. 1) Effective use of controller drugs, 2) Effective use of rescue medications, and 3) Monitoring to ensure optimal control were all targeted behaviors. Parents received asthma education and assistance from trained lay coaches, who tailored the content and frequency of contact to the parents’ preparedness to modify their child’s daily asthma management. The frequency of coaching calls ranged from weekly to monthly. Researchers used a telephone interview to acquire follow-up measurements for each participating family 12 and 24 months after the research.
At 12 and 24 months, the researchers looked at the mean change in 1) the child’s asthma control score, 2) the parent’s quality of life score, and 3) the frequency of urgent care episodes. The proportion of children receiving controller drugs, having maintenance care visits at least twice a year, and having an asthma action plan were secondary outcomes that demonstrated adherence to guideline recommendations by primary care pediatricians. They assessed the intervention’s cost-effectiveness; 950 families with a child 3-12 years old with persistent asthma were enrolled, and twenty-two practices (66 physicians) were randomized (11 per treatment group). The coaching intervention is described in detail.