Pediatric Asthma Outcomes With Physician Cultural Communication Training

The implementation of the evidence-based program, physician asthma care education (PACE) Plus, may result in improvements in provider confidence, perceived skill in communicating cross culturally, and short-term asthma-specific outcomes, but not significant long-term benefits in asthma-specific clinical outcomes in black or Latino/Hispanic pediatric patients with persistent asthma, according to a study published in the Journal of Asthma.

Researchers recruited a total of 112 primary care physicians to participate in a 3-group randomized control trial to compare PACE Plus, PACE, and usual care to determine whether the addition of cross-cultural communication training in addition to PACE (PACE Plus) would improve the asthma outcomes in black and Latino/Hispanic children, as well as to determine whether PACE was effective in improving outcomes in a diverse pediatric population.

A total of 867 families of children with asthma were included in the study: 70.5% were black, and the mean age of the children was 8.2 years. Two thirds of the participating physicians were randomly assigned to receive either PACE Plus or PACE education, whereas the remaining third did not receive training, but was to deliver usual care. The primary outcome of the study was the number of asthma-related emergency department visits measured at baseline and at 9 and 21 months postintervention. The researchers hypothesized that improved outcomes in black and Latino/Hispanic children would be seen in those treated by providers trained with PACE compared with usual care, and more improved outcomes in those trained with PACE Plus compared with PACE.

During the short term, patients whose physicians completed the PACE Plus training demonstrated significant reductions in asthma-related hospitalizations (estimate, −0.09; 95% CI, −0.18 to −0.0003; P <.05); however, there were no differences observed during the long term, and no differences in caregiver satisfaction. There also were no differences between PACE Plus and PACE in caregiver perception of physician communication and counseling behaviors. Patients did report significant improvement over the long term in the patient-centered communication practice of their physicians who completed PACE compared with patients whose physicians were in the controlled condition (estimate, −0.92; 95% CI, −1.85 to 0.002; P <.05).

Physicians who completed the PACE Plus compared with PACE reported significant short-term improvements in patient-centered communication practices, culturally sensitive communication practices, their perception of clinical skills working across cultures, and patient-centered counseling around asthma (P <.05 for all). Further, physicians who completed PACE Plus also reported greater confidence in their asthma counseling practices and communication practices compared with those who completed PACE.

These results were sustained for patient-centered and culturally sensitive communication practices, physician perception of clinical skills working across all cultures, and physician confidence in communication practices during the long term (P <.01 and P <.05, P <.01, and P <.01, respectively).

Interestingly, there was a lack of long-term change in physicians’ confidence and use of patient-centered counseling regarding asthma. Physicians who completed PACE did report long-term culturally sensitive communication practices improvement (estimate, 3.43; 95% CI, 0.58-6.27; P <.05).

Physicians who completed PACE Plus compared with PACE took more visit time for nonurgent issues in the short term with patients diagnosed with asthma for ≥1 years, and with a diagnosis within the last year (P <.05 and P <.03, respectively). Compared with PACE in the long term, control physicians spent more time in the long term for urgent visits with patients diagnosed with asthma within the last year and diagnosed for ≥1 years (P <.01 and P <.05, respectively).

The researchers concluded that education for healthcare providers that included consideration for working with patients across different cultures resulted in an increase in provider confidence and perceived skill in treating diverse patients, more than observed with general communication training education alone. However, there was no change in physicians trained with PACE Plus, but this was likely attributed to the already high performance and communication rates patients had given them at baseline. In addition, short-term asthma outcomes benefited from the training provided, but it was not sustained long term.

Reference

Patel MR, Song PXK, Bruzzese JM, et al. Does cross-culture communication training for physicians improve pediatric asthma outcomes? A randomized trial [published online April 11, 2018]. J Asthma. doi:10.1080/02770903.2018.1455856