Protocolled nurse-led care improves asthma control in pediatric asthma patients in primary care.

Conference: 
SAPC ASM 2024 - Bristol
Talk Code: 
3E.2
Presenter: 
Sara Bousema
Co-authors: 
Arthur M. Bohnen, Dimitris Rizopoulos, Marielle Pijnenburg, Patrick J.E. Bindels, Gijs Elshout.
Author institutions: 
Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Department of Pediatric Respiratory Medicine and Allergology, University Medical Centre Rotterdam

Problem

In children with asthma, daily symptoms and exacerbations have a significant impact on the quality of life of both children and parents. More effective use of asthma medication and, consequently, better asthma control is advocated, since both over- and undertreatment are reported in primary care. Trials in adults suggest that asthma control is better when patients receive a regular medical review. Therefore, protocolled care by the general practitioner may also lead to better asthma control in children. However, such protocolled care by the general practitioner may be time consuming and less feasible.

Approach

We conducted a cluster-randomized controlled trial in the Netherlands examining the effectiveness of nurse-led protocolled care for children with asthma in primary care. Children aged 6-12 years with asthma, using asthma medication and treated in primary care were eligible. Children were randomized in either the protocolled nurse-led care group or the usual care group. The follow-up time was 18 months. Data were derived from questionnaires, spirometry tests and consultations with a practice nurse. The data included patient characteristics, information on medication use, exacerbations and Childhood Asthma Control Test (C-ACT) scores, Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores and the results of spirometry tests.

Findings

In this study, 49 practices in the provinces of Zuid-Holland, Utrecht, Brabant and Zeeland in the Netherlands participated. We included 90 patients; 51 were randomized in the protcolled nurse-led care group and 39 in the usual care group. The mean age was 9.6 years, and 63.3% of the total study sample included males. Asthma control improved significantly over time in the protocolled-nurse led care group as compared to the usual care group. There were no significant differences in the number of reported exacerbations between the groups. Further analysis is in progress.

Consequences

This study shows evidence that protocolled nurse-led care leads to better asthma control in children treated for asthma in primary care. Better compliance to the protocol could improve the outcomes even more.

Submitted by: 
Sara Bousema
Funding acknowledgement: 
This study was funded by ZonMw