Telephone coaching improves QoL in parents of asthmatic children
MedWire News: A telephone coaching program can improve the quality of life (QoL) of parents with asthmatic children by helping to improve disease management at home, US research suggests.
Writing in the Archives of Pediatrics and Adolescent Medicine, Jane Garbutt (Washington University School of Medicine, St Louis, Missouri, USA) and colleagues explain that among children with asthma "care is often episodic, with underuse of controller medications and inadequate home management of acute exacerbations."
They add: "Consequently, many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common."
To investigate whether a telephone-based asthma management coaching program benefits children with asthma and their parents, the team enrolled the families of 362 children, aged 5-12 years, with the respiratory condition who were randomly assigned to the Telephone Asthma Program (TAP) (n=190) or a control group (n=172).
TAP was a 12-month intervention designed to provide telephone-based education and support for parents to help them with the day-to-day management of their child's asthma. The program targeted four key behaviors: using controller medications as prescribed; administering albuterol at the first signs of an asthma attack; having an up-to-date asthma action plan; and having a collaborative relationship with the child's primary care provider that included asthma planning visits at least every 6 months.
Disease-specific QoL was measured at the beginning and end of the study period using the Pediatric Asthma QoL Questionnaire in children and the Pediatric Asthma Caregiver's QoL Questionnaire in parents. For both instruments, answers are expressed on a 7-point scale, with a higher score indicating a better QoL and a change of 0.5 units considered clinically significant. Urgent visits for asthma care were also recorded.
The researchers found that parental QoL scores in the TAP group improved by an average of 0.67 units, from 5.75 to 6.47, during the study period, compared with an improvement of 0.28 units, from 5.92 to 6.22, in the control group - a statistically significant difference of 0.38 units.
There were no significant between-group differences in the children's QoL at the end of the study period, or in the mean number of urgent care events per year.
However, there were significantly greater reductions in levels of very poorly controlled asthma among children in the TAP group over the study period than among those in the control group, as assessed using data on symptom frequency, use of albuterol, the number of school days missed, and the number of courses of oral steroids used.
Garbutt and team conclude: "Participation in the 12-month telephone asthma coaching program resulted in an improvement in the parents' QoL and improved the child's asthma control."
They add: "If the refined intervention proves to be cost-effective, widespread implementation may be possible as it would require minimal practice redesign and would not require additional physician training."
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By Mark Cowen