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(Chest. 2006;129:292-299.)
© 2006 American College of Chest Physicians

An Interdisciplinary Intervention for Undertreated Pediatric Asthma*

Natalie Walders, PhD; Carolyn Kercsmar, MD; Mark Schluchter, PhD; Susan Redline, MD, MPH; H. Lester Kirchner, PhD and Dennis Drotar, PhD

* From the National Jewish Medical and Research Center (Dr. Walders), Denver, CO; the Rainbow Babies and Children’s Hospital (Dr. Drotar), Cleveland, OH; Case School of Medicine (Drs. Kercsmar, Schluchter, Redline, Kirchner), Cleveland, OH.

Correspondence to: Natalie Walders, PhD, Division of Psychosocial Medicine A109, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206; e-mail:waldersn{at}njc.org

Abstract

Study objectives: To examine the effectiveness of an interdisciplinary intervention for pediatric asthma.

Design: Randomized, controlled study.

Setting: Urban tertiary-referral pediatric hospital.

Participants: One hundred seventy-five patients with asthma lacking written treatment plans and presenting with asthma-related emergency department visits (two or more) and/or hospitalizations (one or more) in the past year were randomized to a comparison group receiving medical care alone (n = 86) or to an interdisciplinary intervention group receiving medical care, asthma education, and problem-solving therapy (n = 89)

Intervention: All participants received written asthma management plans, peak flow meters, and spacer devices. The intervention group also received asthma education, an asthma risk profile assessment, brief problem-solving therapy, and access to a 24-h nurse advice line. The primary outcome measure was change in asthma symptoms, and secondary outcomes included health-care utilization and asthma-related quality of life.

Results: Both groups demonstrated significant reductions in asthma symptoms and improvements in quality of life without any between-group differences identified over the course of follow-up. In contrast, the intervention group demonstrated less frequent health-care utilization than the comparison group, with 28% of the intervention group requiring emergency department or inpatient services for asthma compared to 41% of the comparison group (adjusted odds ratio, 1.92; 95% confidence interval, 1.00 to 3.69) over the 12-month follow-up period.

Conclusions: This study examined the effectiveness of an interdisciplinary intervention for undertreated asthma. The intervention did not result in improvements in asthma symptoms, but accomplished modest reductions in the utilization of acute medical care.

Key Words: interdisciplinary intervention • pediatric asthma • problem-solving • randomized controlled trial






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