A multicomponent comprehensive care model may not reduce the number of days of health care outside the home or reduce school absenteeism in children with severe asthma, a study in the Journal of Asthma suggests.
Researchers used a comprehensive care model in this study provided in a high-risk children’s clinic. Parents of the children with asthma who attended this clinic had direct access to their child’s primary care provider for 40 hours a week as well as 24/7 cell phone access to the on-call provider. A multicomponent comprehensive care intervention program was compared to the standard comprehensive care program to assess differences in terms of number of days of healthcare use outside the home and the incidence of school absenteeism.
The multicomponent care model involved school nurses in the treatment process, collaboration with pharmacists to confirm refills, use of motivational interviewing to understand medication adherence, and implementation of portable pulmonary testing to measure forced expiratory volume in 1 second at the onset of asthma symptoms.
Compared with comprehensive care alone, the multicomponent care intervention resulted in approximately twice the number of calls between the staff and families (356 vs 753 per 100 child years, respectively; rate ratio [RR], 2.11; 95% CI, 1.29-3.45; P =.003). There was no evidence that the increased number of calls in the intervention group reduced the composite number of days of health care outside the home compared with comprehensive care only (1179 vs 958 per 100 child-years, respectively; RR, 1.23; 95% CI, 0.82-1.84; P =.31).
The investigators found no evidence that the intervention resulted in a reduction in the number of missed school days (1285 vs 823 per 100 child-years; RR, 1.56; 95% CI, 0.93-2.61; P =.09). According to Bayesian analysis, there was a 67% probability that the multicomponent comprehensive care program could actually increase the total number of treatment days outside the home. Conversely, the analysis indicated only a 14% probability of a reduction of ≥20%.
Limitations of the study included the reliance on refill data to assess treatment adherence as well as the strict inclusion of children with only high-risk asthma.
The researchers suggested that in addition to their main findings, “the study also highlights the need for more creative measures to improve adherence.”
Mosquera RA, Caramel Avritscher EB, Yadav A, et al. Unexpected results of a randomized quality improvement program for children with severe asthma [published online February 6, 2020]. J Asthma. doi:10.1080/02770903.2020