FRANK LEFEVRE, MD MARGARET PIPER, PHD, MPH KEVIN WEISS, MD, MPH DAVID MARK, MD, MPH NOREEN CLARK, PHD NAOMI ARONSON, PHD Chicago, Illinois Technology Evaluation Center, Blue Cross and Blue Shield Association (BCBSA), Chicago IL (F.L., M.P., D.M., N.A.); Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL (F.L., K.W.); Midwest Center for Health Services & Policy Research, Hines VA Medical Center, Hines, Illinois (K.W.); American Medical Association, Chicago, IL (D.M.); University of Michigan School of Public Health, Ann Arbor, MI (N.C.). The authors report no competing interests. Work was developed under contract with the Agency for Healthcare Research and Quality (AHRQ) contract number 290-97-001-5. The Blue Cross Blue Shield Association Technology Evaluation Center is an EvidenceBased Practice Center of the AHRQ. Address for correspondence: Frank Lefevre, MD, Division of General Internal Medicine, Galter Pavilion, 18-200, 675 North St. Clair St, Chicago, IL 60611. E-mail: f-lefevre@northwestern.edu
Existing trials have tended to over-estimate the effects of action plan-based interventions, thus having invested resources for results inadequate for optimizing self-management strategies. Careful consideration needs to be taken in future trials to realistically estimate the expected impact of each intervention, and to specify the primary outcomes of interest and their baseline frequencies. Future trials should be large enough to detect a difference if one exists, or to confidently conclude that the intervention is ineffective.
Attention to these principles will help to advance our knowledge in this area most efficiently and to ultimately improve the quality of care for the entire population of patients with asthma.
· Acknowledgments ·
We acknowledge Kathleen Ziegler, Pharm.D, and Claudia Bonnell, RN, MSL, for their assistance in the research and preparation of this manuscript.
