Study type and design
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Improving Asthma Care in Ministry of Health Primary Care Clinics
of asthmatic patients. All asthma patients who fulfilled the criteria and received treatment at the selected health clinics during the study period were involved and
sampled using convenient quota sampling.
Phase 1 – Planning the intervention package
In this phase, an intervention package was designed: 1.
Flow Chart of Chronic Asthma Management in Adult based on GINA revised 2006 see Appendix A
2. Modified Management Approach Based on Asthma Control see Appendix B
3. Peak Expiratory Flow Rate PEFR monitoring to determine level of asthma
control, and use of Peak Flow Chart during clinic visit. see Appendix C 4.
Asthma Action Plan for patient see Appendix D 5.
Asthma Control Handbook and Asthma Treatment Record for patient. Two weeks before starting the baseline audit Phase 2, all healthcare providers
involved directly in asthma management were briefed and trained based on above interventional package, over one day session see Appendix F1. The target group
of healthcare providers was:
1. Medical officers
2. Assistant medical officers
3. Nurses sister, staff nurse, community nurse
Each new staff who was to get involved in the asthma management in selected clinics was trained by the existing trained healthcare providers in the clinic.
These interventional package and peak flow meters were distributed and made available in all treatment and consultation rooms, where they were used to improve
the asthma control. By using these tools, the healthcare providers were reminded on the steps that need to be taken if patients have partially controlled or uncontrolled
asthma, and that management should be adjusted according to their level of control.
Phase 2 – Baseline Audit with Simultaneous Ongoing Intervention
Data collection on 500 asthmatic patients was collected from all the participating clinics. Patient attending the clinic for continuation of asthma care were selected
by quota sampling, with their card stamped at the screening room see Appendix E.
Age, gender, medications, and asthma symptoms as stated in ACT were self-reported by the patients using the Asthma Action Plan AAP leaflet Appendix D, assisted
by the trained healthcare provider, who was responsible to measure their height and PEFR. The medical officers or assistant medical officers in the treatment or
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Improving Asthma Care in Ministry of Health Primary Care Clinics
Phase 1: Planning intervention package June – August 2008
Design and preparing of intervention package, followed by empowerment of health care providers on:
1. Flow Chart of Asthma Management
2. Modified Management Approach Based on Asthma Control
3. Peak Expiratory Flow Rate PEFR monitoring
4. Asthma Action Plan for patient including ACT
5. Asthma Control Handbook Treatment Record
Phase 2: Baseline audit with simultaneous ongoing intervention August 2008 – February 2009
Pre-intervention data collection on age, gender, medication, asthma control level and PEFR 500 quota samples from 6 intervention clinics
Implementation of the intervention package simultaneously: 1.
Flow Chart of Asthma Management 2.
Modified Management Approach Based on Asthma Control 3.
Peak Expiratory Flow Rate PEFR monitoring during clinic visit 4.
Asthma Action Plan for patient including ACT 5.
Asthma Control Handbook Treatment Record
Phase 3: Post-intervention audit March 2009
Post-intervention data on age, gender, medication, asthma control level and PEFR will be collected at 6 months post-implementation n=500
Figure 1. Flow chart of methodology
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Improving Asthma Care in Ministry of Health Primary Care Clinics
consultation rooms were required to review the AAP leaflet and management of patient were then be based on the Modified Management Approach Appendix B.
This intervention was implemented throughout the 6 months study period August 2008 – February 2009. For each clinic visit, the patients were given a new AAP leaflet
for them to keep record, to reinforce education and empowering.
Phase 3 – Post-intervention Audit March 2009
In this phase, the same 500 asthmatic patients from the selected clinics were reviewed using the AAP leaflet, at 6 months post-implementation.
Post-intervention audit data were provided to the selected health clinics involved, with feedbacks and outcome measures.