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Physician Asthma Education Program Improves Outcomes for Children of Low-Income Families^*

^* From the Department of Pediatrics (Drs. Brown, Bratton, Cabana, and Kaciroti), University of Michigan Health Sciences, and the Department of Health Behavior and Health Education (Dr. Clark), University of Michigan, Ann Arbor, MI.

Correspondence to: Susan L. Bratton, MD, F6884 Mott/0243, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0243; e-mail: Brattons{at}med.umich.edu

Study objectives: To determine whether an interactive physician seminar that has been shown to improve patient/parent satisfaction and to decrease emergency department visits for children with asthma was also effective for those children from low-income families.

Design: Seventy-four pediatricians and 637 of their patients were randomized to receive two asthma seminars or no educational programs and were observed for 2 years.

Setting: Physicians in the New York, NY, and Ann Arbor, MI, areas were enrolled, and, on average, 10 patients with asthma per provider were surveyed and observed for 2 years.

Patients or participants: A total of 637 subjects were enrolled, and 369 subjects remained in the study after 2 years. Of these, 279 had complete medical and survey information.

Interventions: Physicians were randomized, and then a random sample of their patients was enrolled and surveyed regarding the physician’s communication style, the child’s asthma symptoms, medical needs, and asthma care. Low income was defined as annual income of < $20,000.

Measurements and results: The families of 36 children (13%) had an income of < $20,000, and they were treated by 23 physicians. Low-income children in the treatment group tended to have higher levels of use of controller medications, to receive a written asthma action plan, and to miss fewer days of school, although these differences were not statistically significant compared to low-income children in the control group. However, low-income treatment group children were significantly less likely to be admitted to an emergency department (annual rate, 0.208 vs 1.441, respectively) or to a hospital (annual rate, 0 vs 0.029, respectively) for asthma care compared to children in the control group.

Conclusions: The educational program for physicians improved asthma outcomes for their low-income patients. Provider interventions targeted to these high-risk patients may diminish hospital and emergency department asthma care.

Key Words: asthma • communication • controller medications • emergency department • hospitalization • pediatric • physician education

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