Journal Article

Written Action Plan in Pediatric Emergency Room Improves Asthma Prescribing, Adherence, and Control

Noya, Francisco J. D., Zemek, Roger L., McGillivray, David, Chalut, Dominic, Resendes, Sandy, Zhang, Xun, Rouleau, Rachel, Ducharme, Francine M., Khomenko, Lyudmyla

2011

Overview

Abstract Rationale An acute-care visit for asthma often signals a management failure. Although a written action plan is effective when combined with self-management education and regular medical review, its independent value remains controversial. Objectives We examined the efficacy of providing a written action plan coupled with a prescription (WAP-P) to improve adherence to medications and other recommendations in a busy emergency department. Methods We randomized 219 children aged 1–17 years to receive WAP-P (n = 109) or unformatted prescription (UP) (n = 110). All received fluticasone and albuterol inhalers, fitted with dose counters, to use at the discretion of the emergency physician. The main outcome was adherence to fluticasone (use/prescribed × 100%) over 28 days. Secondary outcomes included pharmacy dispensation of oral corticosteroids, β2-agonist use, medical follow-up, asthma education, acute-care visits, and control. Measurements and Main Results Although both groups showed a similar drop in adherence in the initial 14 days, adherence to fluticasone was significantly higher over Days 15–28 in children receiving WAP-P (mean group difference, 16.13% [2.09, 29.91]). More WAP-P than UP patients filled their oral corticosteroid prescription (relative risk, 1.31 [1.07, 1.60]) and were well-controlled at 28 days (1.39 [1.04, 1.86]). Compared with UP, use of WAP-P increased physicians' prescription of maintenance fluticasone (2.47 [1.53, 3.99]) and recommendation for medical follow-up (1.87 [1.48, 2.35]), without group differences in other outcomes. Conclusions Provision of a written action plan significantly increased patient adherence to inhaled and oral corticosteroids and asthma control and physicians' recommendation for maintenance fluticasone and medical follow-up, supporting its independent value in the acute-care setting. Clinical trial registered with www.clinicaltrials.gov (NCT00381355).

• Publisher: Oxford University Press,American Thoracic Society
• Subject: Adolescent / Adrenal Cortex Hormones / Advance Care Planning - organization & administration / Albuterol - therapeutic use / Androstadienes - therapeutic use / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Asthma / Asthma - drug therapy / Asthma - therapy / Biological and medical sciences / Bronchodilator Agents - therapeutic use / Child / Child Health Services / Child, Preschool / Drug dosages / Drug Prescriptions - statistics & numerical data / Emergency and intensive care: techniques, logistics / Emergency medical care / Emergency Service, Hospital - organization & administration / Fluticasone / Follow-Up Studies / Humans / Infant / Inhalers / Intensive care medicine / Intensive care unit. Emergency transport systems. Emergency, hospital ward / Medical sciences / Nebulizers and Vaporizers / Parents & parenting / Patient Compliance - statistics & numerical data / Patients / Pediatrics / Pediatrics - methods / Pharmacy / Physicians / Quality of life / Questionnaires / Self Care - methods / Single-Blind Method / Steroids / Treatment Outcome