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Open Access Study protocol

Partner randomized controlled trial: study protocol and coaching intervention

Jane M Garbutt125*, Gabrielle Highstein3, Yan Yan4 and Robert C Strunk1

Author affiliations

1 Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University, St Louis, USA

2 Department of Medicine, Washington University, St Louis, USA

3 Winds of Change at Crosswinds, 154 Hatchville Road, East Falmouth, MA 02536, USA

4 Department of Surgery, Washington University, St Louis, USA

5 General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660S. Euclid Ave., St. Louis, MO 63110, USA

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Citation and License

BMC Pediatrics 2012, 12:42  doi:10.1186/1471-2431-12-42

Published: 2 April 2012

Abstract

Background

Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice.

Methods and design

This paper describes the protocol for a randomized controlled trial (RCT) to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1) effective use of controller medications, 2) effective use of rescue medications and 3) monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview.

The primary outcomes were the mean change in 1) the child's asthma control score, 2) the parent's quality of life score, and 3) the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications, having maintenance care visits at least twice a year, and an asthma action plan. Cost-effectiveness of the intervention was also measured.

Discussion

Twenty-two practices (66 physicians) were randomized (11 per treatment group), and 950 families with a child 3-12 years old with persistent asthma were enrolled. A description of the coaching intervention is presented.

Trial registration

ClinicalTrials.gov identifier NCT00860834.

Keywords:
Asthma; Behavioral skills training; Lay coaching