AAFP NRN Recruiting Family Medicine Practices for Asthma Research

The AAFP National Research Network, or AAFP NRN, and the Olmsted Medical Center, Rochester, Minn., are recruiting 20 family medicine practices in nonmetropolitan areas to evaluate asthma management tools designed specifically for primary care.

Researchers at the Olmsted Medical Center began developing the asthma APGAR system for managing chronic asthma in 1999. The system was developed to make implementation of asthma guidelines easier in family medicine practices. Tools in the APGAR system include a patient survey that solicits information about how a patient's breathing problems affect

The asthma APGAR system also includes an algorithm that incorporates recommendations for patient education, inhaler technique evaluation and employing follow-up visits for monitoring asthma management.

Researchers from the Olmsted Medical Center published an article summarizing three previous studies of the APGAR tools in the Journal of Asthma and Allergy in 2008. The article concluded that the tools in the system can be feasibly implemented in primary care practices and that their implementation is associated with increased compliance with asthma management guidelines.

However, Barbara Yawn, M.D., MSc., director of research at the Olmsted Medical Center and adjunct professor of family and community health at the University of Minnesota, said the most recent study involved only about 200 patients at five practices. A new study, supported by a $2.49 million grant from the Agency for Healthcare Research and Quality, will include about 1,500 patients.

"Previous studies were just validating the tools and improving the tools to the point that everyone was comfortable using them," Yawn told AAFP News Now. "Those small studies have shown that using the asthma APGAR tools can improve patients' asthma outcomes, but we need a much larger study to confirm those results."

Yawn and her co-authors noted in their 2008 article that implementation of asthma guidelines in primary care practices lowers emergency health care resource utilization and improves patient outcomes. However, many practices have been slow to implement guidelines into daily practice.

"Basic information, such as symptom frequency, frequency of missed or modified activities due to those symptoms, and information on triggers and therapy adherence, appear in less than 40 percent of primary care medical record notes for asthma visits," they wrote. "Without this basic information, it is difficult, if not impossible, to assess the effectiveness of current asthma control or reasons for failure to achieve asthma control."

Yawn said the study has three specific aims:

"Everyone wants to give the best care possible, but few people have access to tools that have been developed and tested by primary care physicians to facilitate best practices," Yawn said. "That's what this study will give practices that participate. Instead of tools developed by subspecialists for more specialized use, these are really primary care tools."

Physicians interested in participating may contact Debbie Graham, associate research director for the AAFP NRN, or project manager Susan Bertram, of the Olmsted Medical Center.

One physician and a designated study coordinator from each participating practice will attend a two-day training session in December in San Antonio, and practices will begin enrolling patients early next year, Yawn said.

She added that researchers are looking for nonmetropolitan practices that are not family medicine residency programs and that employ two to 12 primary care physicians. Each practice must enroll at least 70 patients with asthma -- ranging in age from 5-45 years -- during a 15-month period. Physicians should be prepared to commit 30 months to the project, said Yawn.