Investigators have conducted an evidence-based project to implement the Asthma Control Test (ACT) — a screening tool recommended by the National Heart, Lung, and Blood Institute for periodic assessment of asthma control — into primary care practice. The goal: improve management of primary care patients with asthma by more accurately addressing asthma control.
The project, a pre- and post-implementation study that compared 2 groups of children ages 4 to 14 years with asthma seen at a clinic over 5-week periods, was described in an article in the Journal of Pediatric Health Care.
The following were the specific aims and objectives:
- To develop and implement an educational program for providers (resident physicians and advanced practice registered nurses) and nursing staff at the primary care center to increase their knowledge about assessment of asthma control using the Childhood ACT (C-ACT) and the ACT.
- To increase compliance with the use of the validated C-ACT or the ACT during well-child and asthma visits.
- To prompt providers to adjust asthma treatment based on the C-ACT or ACT score as recommended by national guidelines.
After the educational program and project were implemented, 82.6% of APRNs and 30.7% of pediatric resident physicians used an ACT; 9 (21%) patients considered not well-controlled were identified. All of the children identified as not well-controlled through the ACT received an adjustment in their medication therapy.
The authors offered the following insights:
- Asthma is a complex, chronic illness that requires frequent follow-up and assessment of control.
- Long-term uncontrolled asthma can lead to a decline in lung function over time and may lead to chronic obstructive pulmonary disease in adulthood.
- Primary care providers play an important role in assessing and maintaining asthma control. Rates of uncontrolled asthma and under- or overestimation of asthma control from the patient, parent, or provider perspective are high in primary care.
- The ACT, as a numeric score, may be a useful way to track asthma control over time to determine whether therapy has optimized asthma control.
- In the future, allowing the patient and family to complete the questionnaire on a mobile application, which could be directly uploaded into the medical record, would save time for the provider.
- Use of the questionnaire may improve the patient’s and parent’s knowledge related to symptom monitoring and improve self-management skills.
The authors concluded that the C-ACT and ACT are simple, self-administered, validated questionnaires that can easily be incorporated into a primary care practice to assess the level of asthma control and to identify patients with asthma that is not well controlled.
“Uncontrolled asthma can negatively affect a patient’s quality of life, school attendance, and work performance,” they stated. “Every patient visit, regardless of the reason, is an opportunity to assess asthma control using a standardized tool.”
Last updated on 9/14/19.