Ducharme FM et al. Written Action Plan in Pediatric Emergency Room Improves Asthma Prescribing, Adherence and Control. American Journal of Respiratory & Critical Care Medicine, August 27, 2010.

An acute-care visit for asthma often signals a management failure. While a written action plan is effective when combined with self-management education and regular medical review, its independent value remains controversial. Ducharme and colleagues examined the efficacy of providing a written action plan coupled with a prescription (WAP-P) to improve adherence to medications and other recommendations in a busy emergency department. They randomized 219 children aged 1-17 years to receive WAP-P (N=109) or unformatted prescription (UP) (N=110). All received fluticasone and albuterol inhalers, fitted with dose counters, to use at the discretion of the emergency physician. The main outcome was adherence to fluticasone (use/prescribed x100%) over 28 days. Secondary outcomes included pharmacy dispensation of oral corticosteroids, beta2-agonist use, medical follow-up, asthma education, acute-care visits, and control.
Though both groups showed a similar drop in adherence in the initial 14 days, adherence to fluticasone was significantly higher over days 15-28 in children receiving WAP-P [mean group difference: 16.13% (2.09, 29.91)]. More WAP-P than UP patients filled their oral corticosteroid prescription [Relative risk: 1.31 (1.07, 1.60)] and was well-controlled at 28 days [1.39 (1.04, 1.86)]. Compared to UP, use of WAP-P increased physicians prescription of maintenance fluticasone [2.47 (1.53, 3.99)] and recommendation for medical follow-up [1.87 (1.48, 2.35)], without group differences in other outcomes.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that provision of a written action plan significantly increased patient adherence to inhaled and oral corticosteroids and asthma control, as well as physicians' recommendation for maintenance fluticasone and medical follow-up that supports its independent value in the acute-care setting.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: The results of an adherence study conducted over a 28 day period mean little. The study should have been conducted for at least 12 months to yield any meaningful data.