Castro 2003.
| Methods | RCT, patient recruitment: hospital inpatients admitted for dyspnoea Setting: inpatient and outpatient setting, Barnes‐Jewish Hospital, Missouri, USA |
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| Participants |
Control patients: n = 46, women: 85%, mean age: 38, moderate‐severe asthma (according to FEV1), FEV1: 58%, ICS use: not reported Intervention patients: n = 50, women: 80%, mean age: 35, moderate‐severe asthma (according to FEV1), FEV1: 57%, ICS use: not reported |
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| Interventions |
Name and duration of programme: Use of an asthma nurse specialist to provide a multifaceted approach to asthma care for “high‐risk” inpatients, tailored to patients, during 6 months Intervention group components Organisational ‐ patients: psychosocial support and screening for professional counselling; consultation with social services to facilitate discharge planning; provision of outpatient follow‐up through phone contact and home visits as necessary; assessing need for allergy skin testing Organisational ‐ healthcare professionals/system: teamwork and collaborative processes between providers (suggestion by nurse to GP regarding current regimen, flow sheet as direct communication between nurse and GP); explicit use of EBM for care (regimen in accordance with National Asthma Education and Prevention Program II); daily 'asthma care' flow sheet Patient education: one on one education on management of the disease, prevention of exacerbation, smoking cessation, use of spacer, medication delivery technique, peak flow monitoring Self‐management support: asthma self‐management plan Frequency: tailored to patients Healthcare professionals involved: GPs; respiratory care nurses Control group components Usual care (which includes asthma education as well as inhaler technique and peak flow monitoring by respiratory therapist and nurse in hospital) Number of components and dominant component: 10, mixed (organisational ‐ patients, organisational ‐ healthcare professionals or system) |
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| Outcomes |
Organisational level Healthcare utilisation: asthma‐related hospitalisations (absolute number, mean number per patient) (primary); non‐asthma‐related hospitalisations (absolute number, mean number per patient); GP visits (absolute number, mean number per patient); ED visits (absolute number, mean number per patient); asthma‐related hospital days (absolute number, mean number per patient); non‐asthma‐related hospital days (absolute number, mean number per patient); mean time to readmission; mean healthcare costs per patient Costs: total healthcare costs per patient Patient level Quality of life: AQLQ score: overall, activity, symptom, emotional, and environmental scores Time of outcome measurement: at 6 mo |
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| Notes | AQLQ: Asthma Quality of Life Questionnaire | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "study patients were randomly assigned in a blind selection procedure using a pre‐randomised assignment in a sealed letter" |
| Allocation concealment (selection bias) | Low risk | See supra |
| Blinding (performance bias and detection bias) All outcomes | High risk | Data were collected by asthma nurses who knew allocation status |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data on all randomised patients |
| Selective reporting (reporting bias) | Unclear risk | No protocol |
| Other bias | Low risk | No other bias detected |
| Outcomes at baseline similar? | Unclear risk | No measurement of primary outcome at baseline. ED visits at baseline: 4.8 versus 5.6, but not significant |
| Characteristics at baseline similar? | Low risk | "both groups were well balanced with respect to all baseline characteristics, and there was no significant differences between the groups" |
| Adequate protection against contamination? | Unclear risk | Unclear if GP saw both intervention and control patients |