The Asthma Toolkit Bootcamp to Improve Rural Primary Care for Pediatric Asthma.

ABSTRACT Background Children with asthma living in rural areas receive most of their care from primary care providers (PCPs) who have variable knowledge of evidence-based guideline management. Objective To test the capacity of The Asthma Toolkit Bootcamp (ATB) program to improve PCP guidelines adherence and reduce healthcare utilization in rural children with asthma. Methods The ATB program provided intensive training in NHLBI guidelines-based asthma care, evaluated within a RE-AIM implementation science framework. All primary care practices serving pediatric patients in rural La Plata County, Colorado received 1) online instruction, 2) full-day training, and 3) follow-up, in-practice training one month later. Training focused on spirometry use, severity and control assessment, medication management, asthma action plan utilization, and adoption of a standardized visit protocol. Results RE-AIM evaluation determined successful enrollment of practices in La Plata County (Reach) and provider uptake of evidence-based practices including spirometry (Adoption). Pediatric asthma patients receiving spirometry increased from 22% pre- to 86% post-training; severity assessment from 47-88%; and action plans from 40-86%. Significant improvements in healthcare utilization were observed among trained practices including a 10% decrease in ED visits, 35% decrease in hospital admissions, and 29% decrease in oral corticosteroid prescriptions (Effectiveness). Comparison practices showed no significant reductions in healthcare utilization. Participating providers reported that having the training in their own community, intense practice, a team-based approach, and cost-free materials including the spirometer and patient education materials were particularly helpful. Conclusion The Asthma Toolkit Bootcamp improved pediatric asthma care given by rural providers and reduced healthcare utilization among their patients.