Table BSummary of the strength of evidence in support of eight interventions designed to modify clinician adherence to asthma guidelines

InterventionOutcome: Prescription of Controller MedicationsOutcome: Patient Education/Asthma Action PlansOutcome: ED Visits/HospitalizationsOutcome: Missed Days of Work/School
Decision supportBenefit with large magnitude of effect.
SOE moderate.
Studies consistently favor intervention with large magnitude of effect.
SOE moderate.
Benefit with moderate magnitude of effect (larger in pre-post studies).
SOE moderate.
Unable to conclude due to inconsistent results.
SOE insufficient.
Organizational changeBenefit with small magnitude of effect.
SOE low.
Two studies show benefit with moderate magnitude of effect.
SOE low.
No benefit with range of magnitudes of effect.
SOE low.
No benefit (for missed school days).
SOE low.
Feedback and auditBenefit with moderate magnitude of effect.
SOE moderate.
Benefit with low magnitude of effect.
SOE low.
No conclusion could be made due to conflicting results in few studies.
SOE insufficient.
No conclusion due to inconsistent results in one included study.
SOE insufficient.
Clinical pharmacy supportBenefit within three studies with moderate magnitude of effect.
SOE moderate.
Benefit in one study with moderate magnitude of effect.
SOE moderate.
Unable to make a conclusion based on one study with imprecise results.
SOE insufficient.
No studies.
SOE insufficient.
Education onlyNo benefit.
SOE low.
Small to moderate increases in a minority of studies.
SOE low.
No benefit. Inconsistent results (reductions and increases).
Low SOE.
No conclusion due to inconsistent and imprecise estimates of effect in five studies.
SOE insufficient.
QI and pay-for-performanceNo studies.
SOE insufficient.
Observational studies showed benefit, while the RCT did not. Benefit with moderate magnitude of effect.
SOE low.
No benefit.
Low SOE.
Unable to draw conclusions. One study (with high risk of bias) reported a nonsignificant reduction in school days missed.
SOE insufficient.
Multicomponent interventionsBenefit with moderate magnitude of effect.
SOE low.
Benefit, with moderate magnitude of effect (larger in observational studies).
SOE low.
Unable to make conclusion; while the one study reported a large reduction, the study quality was low.
Insufficient SOE.
No conclusion; One study reported a large reduction, but study quality was low.
SOE insufficient.
Information onlyNo studies.
SOE insufficient.
No studies.
SOE insufficient.
Unable to make conclusion; no difference seen, but study quality was low.
SOE insufficient.
No studies.
SOE insufficient.

ED = emergency department; QI = quality improvement; RCT = randomized controlled trial; SOE = strength of evidence

From: Executive Summary

Cover of Interventions to Modify Health Care Provider Adherence to Asthma Guidelines
Interventions to Modify Health Care Provider Adherence to Asthma Guidelines [Internet].
Comparative Effectiveness Reviews, No. 95.
Okelo SO, Butz AM, Sharma R, et al.

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