Does Shared Decision-Making Improve Asthma Outcomes?

This study has been completed.
Sponsor:
Information provided by:
National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier:
NCT00149526
First received: September 6, 2005
Last updated: January 18, 2008
Last verified: January 2008
  Purpose

To improve asthma outcomes by developing and evaluating strategies for enhancing the clinic-patient partnership. To develop a model of shared decision-making for asthma treatment, and to evaluate it in a two-year randomized clinical trial in 342 adults aged 18-70 years with sub-optimally controlled persistent asthma.


Condition Intervention
Asthma
Behavioral: Shared Decision-Making

Study Type: Interventional
Study Design: Allocation: Randomized
Primary Purpose: Treatment

Resource links provided by NLM:


Further study details as provided by National Heart, Lung, and Blood Institute (NHLBI):

Study Start Date: June 2001
Estimated Study Completion Date: May 2006
Detailed Description:

BACKGROUND:

Although much is now known about asthma, and there is effective asthma treatment, only about half of the patients with persistent asthma adhere to their prescribed long-term controller medication. One way to change this might be to involve patients more in decisions about their treatment.

DESIGN NARRATIVE:

Overview and study design This study is designed to evaluate the effectiveness of a model of shared decision-making in improving outcomes in adults aged 18-70 years with suboptimally controlled, mild-moderate persistent asthma. The shared decision-making model (SD) is being compared in a randomized controlled trial with a model based on national asthma guidelines (MG), and with usual care (UC).

Initially, we adapted the model of shared decision-making that has been used successfully in cancer to make it appropriate for a chronic disease (asthma). We will also adapted the KP Asthma Guidelines so that the two models (Management by Guidelines and Shared Decision-Making) take a similar amount of clinician-patient interaction time. We are comparing the two models and usual care in the primary care setting at Kaiser Permanente Northwest and Kaiser Permanente Hawaii in a randomized controlled trial with 24-month follow up. The individual asthma patient will be the unit of randomization.

Interventions were done by a care manager (nurse practitioner or clinical pharmacist) with experience in asthma, and the authority to change medication regimens. Different staff were used for the two intervention groups to minimize contamination between the groups attributable to the intervention. Eligible participants were randomized into the three groups (UC, MG, and SD) on an equal 1:1:1 basis, stratifying on prior health care utilization and within center (KPNW or KPH). All study participants are being followed for 24 months with clinic visits for data collection at 12 months. The MG and SD arms are receiving interim phone calls from the care managers at three, six, and nine months to assess problems with their treatment regimens, discuss changes that may be desired in treatment regimens, and encourage adherence. Different staff are responsible for data collection and intervention.

We will compare the MG and SD models versus usual care (UC vs MG; UC vs SD), and the MG and SD models (MG vs SD).

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion: Asthma not well-controlled; doctor-diagnosed asthma; currently taking asthma medications; 12 % and 200ml increase in FEV1 after 2 puffs of an inhaled short-acting -agonist (SABA) bronchodilator ; 2 or more control problems identified using the ATAQ asthma control instrument; 18-70 years of age; willing to be randomized to one of the three treatment arms and to participate in follow-up for 2 years; Kaiser Permanente member for 1 year

Exclusion: Mild intermittent asthma, defined as either seasonal asthma or (daytime asthma symptoms <2x/week and nocturnal symptoms <2x/month and no use of controller medications); under the ongoing care of an allergist or pulmonologist; regular use of oral corticosteroids; currently receiving case-management for their asthma; unable to speak, read or understand English; planning to leave the catchment area within the next two years

  Contacts and Locations
No Contacts or Locations Provided
  More Information

No publications provided by National Heart, Lung, and Blood Institute (NHLBI)

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00149526     History of Changes
Other Study ID Numbers: 261
Study First Received: September 6, 2005
Last Updated: January 18, 2008
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Asthma
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases

ClinicalTrials.gov processed this record on April 16, 2014