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A Randomized Trial of Clinician Prompting in Pediatric Offices

Jill S. Halterman, MD, MPH; Susan Fisher, PhD; Kelly M. Conn, MPH; Maria Fagnano, BA; Kathleen Lynch, BA; Andrew Marky, BA; Peter G. Szilagyi, MD, MPH

Arch Pediatr Adolesc Med. 2006;160:1018-1025.

Objective  To determine whether clinician prompting regarding a child's symptom severity and guideline recommendations at the time of an office visit improves the delivery of preventive asthma care.

Design  Randomized controlled trial.

Setting  Two inner-city pediatric practices in Rochester, NY.

Participants  Two hundred twenty-six children with persistent asthma (aged 2-12 years) presenting to the clinics for well-child care, asthma care, or non–asthma-related illness care.

Intervention  We assigned children randomly to a clinician-prompting group (single-page prompt including the child's symptoms and guideline recommendations given to the clinician at the time of the visit) or a standard-care group (no prompt given). Interviewers called parents after the visit to inquire about preventive measures taken, and medical charts were reviewed.

Main Outcome Measures  Any preventive action related to asthma taken at the visit.

Results  Children in the clinician-prompting group were more likely to have had any preventive measures taken at the visit compared with children in the standard-care group (87% vs 69%). Specifically, visits for children in the clinician-prompting group were more likely to include delivery of an action plan (50% vs 24%), discussions regarding asthma (87% vs 76%), and recommendations for an asthma follow-up visit (54% vs 37%). In a regression model, children in the clinician-prompting group had 3-fold greater odds of receiving any preventive action compared with the standard-care group.

Conclusion  Clinician prompting regarding asthma severity and care guidelines at the time of an office visit significantly improved the delivery of preventive asthma care.

Author Affiliations: Departments of Pediatrics (Drs Halterman and Szilagyi; Mss Conn, Fagnano, and Lynch; and Mr Marky) and Community and Preventive Medicine (Dr Fisher), University of Rochester School of Medicine and Dentistry, and the Strong Children's Research Center (Drs Halterman and Szilagyi; Mss Conn, Fagnano, and Lynch; and Mr Marky), Rochester, NY.

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