 Through a collaborative with the Washington University Pediatric and Adolescent Ambulatory Research Consortium (WUPAARC), the National Institutes of Health (NIH) has provided Washington University Department of Pediatrics a $5.9-million grant that will apply a coaching intervention to enhance parental asthma management. Combining experiences from several diverse asthma studies, Robert Strunk, MD, and Jane Garbutt, MB, Ch.B., will begin the five-year investigation that will employ coaches to empower mothers of children with asthma to better manage their child’s asthma through a collaborative relationship with their child’s primary care physician and encourage more effective use of maintenance medication.
Today, more children are treated for asthma than ever before, and through a research effort underway at St. Louis Children’s Hospital, Drs. Robert Strunk and Jane Garbutt will study asthma management via the offices of community pediatricians who participate in the Washington University Pediatric and Adolescent Ambulatory Research Consortium (WUPAARC). Founded in 2002, WUPAARC is a practice-based research network of community pediatricians established to further clinical and translation research.
“Our consortium of pediatricians and pediatric nurse practitioners serves as a laboratory for doing clinical research that is relevant to primary care, and this setting has proven to be the perfect mechanism for conducting these types of studies,” says Dr. Garbutt, WUPAARC program director. “Earlier WUPAARC studies looked at other topics that are important for primary care practitioners, such as the prevalence of antibiotic-resistant organisms in the community and the evaluation of a novel treatment for obesity.” Drs. Garbutt and Strunk first collaborated in a randomized trial to evaluate whether a telephone asthma coaching program could reduce asthma morbidity among children, but this program was not integrated into the primary care practice.
“In all of our asthma coaching projects over the past 10 years, we’ve been successful in getting parents back to their doctor so that the coached parents had many more visits to their doctor than the controls. However, because our findings showed little impact on subsequent emergency visits or urgent care, just getting patients back to the doctor apparently didn’t provide parents the facilities to manage the asthma,” reveals Dr. Strunk, a member of the Division of Allergy, Immunology, and Pulmonary Medicine at St. Louis Children’s Hospital and the Donald Strominger Professor of Pediatrics.
“We concluded that work on the partnership between parent and doctor was needed, and that is what this newest effort will study,” he reflects. “Doctors are good at reacting when the patient has a problem and are effective at adjusting medications and managing the acute exacerbation. Doctors are not so good at identifying when the child’s asthma control is inadequate, perhaps because the parent does not know when that occurs. Often, there is a disconnect at a fundamental level in the relationship as it relates to asthma between the mother and the doctor, and we hope our work can to put those two together.”
St. Louis Children’s Hospital is a national leader in treating childhood asthma, and provides a center that is participating in three additional NIH-funded childhood asthma research networks directed by Dr. Strunk and his colleagues, including the Children’s Asthma Management Program (CAMP), Childhood Asthma Research and Education Network (CARE) and the Inner City Asthma Consortium (ICAC).
“Coaching will be tailored to the individual mother,” states Dr. Garbutt. “Even if the parent is very competent, our previous research suggests that parents appreciate the support and encouragement that they are doing the right things.” The randomized study will enroll 24 primary care pediatricians and approximately 40 patients with asthma from each practice. Children will be followed for two years.
Through his practice and research, Dr. Strunk has come to realize that parents usually don’t have expectations that their child can live a normal life and believe that wheezing, missing school and waking up at night is typical. “Children with asthma can achieve whatever they want, for only a tiny, tiny fraction of all children with asthma have limitations,” he adds. “The idea behind the study is to give parents more skills in managing asthma with their doctor and to educate mothers as to what they should look for to achieve better control.” |