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by Bruce G. Bender, PhD, Perry Dickinson, MD, Allison Rankin, MPH, Frederick S. Wamboldt, MD, Linda Zittleman, MSPH, and John M. Westfall, MD, MPH

Introduction: Asthma is often under-diagnosed and under-treated in primary care. The Colorado Asthma Toolkit Program was initiated to establish a method for improving asthma care by providing to primary care practices coaching, training, and support for (1) evidence-based asthma diagnosis and treatment, and (2) education and activation of patients toward effective self-management of their illness.

Methods: A collaborative program was initiated involving 2 academic medical institutions and the High Plains Research Network, a primary care practice-based research network in eastern Colorado. Focus groups were conducted with rural Colorado patients and health care clinicians to assess need and determine the most effective intervention strategies. Two intertwined training programs, or “toolkits,” were subsequently developed, one each for health care clinicians and patients. Clinicians received 3 coaching sessions conducted by 2 nurses in the practice that included training in guideline-based meth- ods for evaluation and treatment of asthma, coaching to assist practices in implementing these methods, and training in communication techniques to promote asthma self-management. Practices were also given a spirometer and trained in its use and interpretation. Patient self-management toolkits were pro- vided to clinicians, who were trained to use the materials to educate patients and increase treatment adherence. Evaluations were based on practice interviews 1 to 3 months after coaching.

Results: Coaching occurred in 57 of the 58 primary care offices in eastern rural and semirural Colo- rado. Practices reported changes in their asthma management behaviors: (1) 40.4% of practices in- creased their use of inhaled corticosteroids, with the median percent of patients taking inhaled cortico- steroids rising from 25% to 50%; (2) 53.2% of practices increased their use of asthma action plans, with the median percent of patients with action plans rising from 0% to 20%; and (3) 78.7% of practices ini- tiated or increased their use of spirometry, resulting in a rise in median use from 0% to 30%.

Conclusion: The Colorado Asthma Toolkit Program successfully disseminated asthma care training into a majority of area rural health care practices. Acceptance by practices was attributable to flexible, in-office coaching and provision of spirometry. Significant shifts seen in asthma-management practices are likely to reduce hospitalizations and emergency department visits. ( J Am Board Fam Med 2011;24:240 –248.) Keywords: Asthma, Evidence-based Guidelines, Provider Training

(J Am Board Fam Med 2011;24:240–248)