Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial

ABSTRACT

Objective: Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children. Methods: A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures. Results: Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial. Conclusion: PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care.

Trial registration: ClinicalTrials.gov: NCT01251523 December 1, 2010.

Trial registration: ClinicalTrials.gov identifier: NCT01251523.

KEYWORDS:

• Pediatrics
• education
• control/management
• treatment
• guidelines

Acknowledgements

This work was supported by the Lung Division of the National Heart, Lung, and Blood Institute of the National Institutes of Health (Brown- R01HL093386-01-A2). The authors would like to thank Matthew Shankin, Kausar Hafeez, Margaret Wilkin, Emily Salvette, Daniel Awad, Harim Yoo, and study participants for their contributions to this work. This work is dedicated to the loving memory of Dr. Noreen M. Clark, Director of the Center for Managing Chronic Disease at the University of Michigan School of Public Health.

Declaration of interest

The authors have no competing interests relevant to the proposed work. Dr. Brown reports personal fees from AstraZeneca, personal fees from Meda, personal fees from Teva, personal fees from ThermoFisher, non-financial support from Allergy and Asthma Network, non-financial support from National Asthma Educator Certification Board, outside the submitted work. Dr. Meyerson reports personal fees from GlaxoSmithKline, personal fees from Teva Pharmaceuticals, personal fees from Medscape, outside the submitted work.

Table E3. Changes in symptom and asthma health care utilization, quality of life and satisfaction measured at baseline, 9 months, and 21 months.

Table E4. Changes in patient perception in provider's communication and counseling practice over the short and long term, measured at baseline, 9 months, and 21 months.

Table E5. Changes in physician perception of communication and asthma counseling practices over the short and long term, measured at baseline, 9 months, and 21 months.

Table E6. Changes in visit time over the short term and long term measured at baseline, 9 months, and 21 months.

Additional information

Funding

Lung Division of the National Heart, Lung, and Blood Institute of the National Institutes of Health R01HL093386-01-A2.