Identifying Which Urban Children With Asthma Benefit Most From Clinician Prompting: Subgroup Analyses From the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) Trial

Abstract

Objective: Clinician prompts increase the likelihood of guideline-recommended corrective actions (preventive medication prescription, dose change, and/or adherence promotion) for symptomatic children with poorly controlled or persistent asthma in the primary care setting, but it is unclear if all children equally benefit. The objectives of this study were to identify whether asthma severity, visit type, and current preventive medication use were predictive of corrective actions during visits for children with symptomatic asthma, and determine whether these factors modified the effect of a prompting intervention.

Methods: We conducted prespecified subgroup analyses of a cluster randomized controlled trial of physician prompting that promoted guideline-based asthma management for urban children with symptomatic asthma. We tested predictors of corrective actions with bivariate and multivariate multilevel logistic regressions, compared intervention effects across factor categories via stratified analyses, and characterized effect modification with interaction term analyses.

Results: Prompting intervention exposure, moderate/severe disease, asthma-focused visits, and current preventive medication use were predictive of corrective actions. The prompting intervention significantly increased the rate of corrective actions for children across categories of disease severity, visit type, and preventive medication use. However, the intervention effect was significantly smaller for children already using a preventive medication (adjusted odds ratio [OR], 2.01; 95% confidence interval [CI], 1.19-3.38) compared with children without preventive medication use (adjusted OR, 6.25; 95% CI, 3.39-11.54).

Conclusions: Prompting increases the likelihood of corrective actions during clinic encounters; however, children already using preventive medication benefit less. It is critical for providers to recognize the need for corrective actions among these symptomatic children.

Trial registration: ClinicalTrials.gov NCT01105754.

Keywords: asthma; childhood; prevention; primary care; provider prompting; subgroup analysis.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to disclose

Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Adjusted Odds Ratio for Corrective Actions with PAIR-UP Intervention Stratified on Visit Type, Current Preventive Medication Use, and Asthma Severity a Multilevel logistic regression with matched pair fixed effects and practice random effects; covariates include gender, age, race, ethnicity, insurance type, and caregiver smoking status