1. Challenges in recruiting primary care doctors for a randomized controlled trial to study change in prescription practices due to our educational intervention
Dr. Monica Barne1, Dr. Sharad Agarkhedkar2, Dr. Avinash Bhondawe3, Priyanka Thakare1, Noopur Hedawoo1, Sapna Madas1, Dr. Aarti Nagarkar4, Dr. Sundeep Salvi1
1Chest Research Foundation,
2Dr. D. Y. Patil Medical College,
3Indian Medical Association,
4Savitribai Phule Pune University

2. Background India: A country of increasing Asthma Prevalence
India: A country of misdiagnosis/under diagnosis of Asthma
India: A country of inappropriate management of Asthma
India needs effective knowledge up-gradation of correct Asthma practices amongst medical practitioners

3. Aim of our study
To recruit doctors to participate in a study to find out if our one day training programme in Asthma, ‘CHAMPS’ has any impact in improving the prescription practices, knowledge and attitude of primary care practitioners in Pune city in India.

4. Methodology Randomized, controlled single blinded interventional study
In collaboration with the Indian Medical Association and College of General Practitioners in Pune, India.

5. Inclusion Criteria Primary Health care doctors
Age: 25 to 50 years Gender: Males and Females
Qualified primary care practitioners. MBBS, MD (General Medicine), DNB (Med), MD (Pediatrics), DNB (Pediatrics), MBBS (DCh)
In private practice for > 2 years
Having independent private clinic
Doctors not managing Asthma according to the GINA guidelines.
Willing to participate in the study after informed consent.
Data obtained from the records of the Indian Medical Association

6. Keep carbon copy of all respiratory prescriptions x 1 month
Screening
To identify a pool of doctors non adherent to GINA guidelines as gold standard for correct practices in Asthma
Included in study and Randomized into
Prescription scoring will done for adherence to GINA guidelines
All doctors included in screening
Keep carbon copy of all respiratory prescriptions x 1 month
Scores 1 and 2
Study group
Control group
Scores 3 and 4
Exclude from study

7. Scoring system for analyzing the prescriptions
Criteria
Score
Doctors prescribing appropriate GINA guideline based inhalation therapy 4
Doctors using Inhaled Corticosteroids and bronchodilators or Leukotriene antagonists as add on therapy. 3
Prescribing only bronchodilator inhalers or inappropriate combinations of inhalers or Leukotriene antagonists as monotherapy 2
Prescribing oral medications (Oral beta agonists, theophyllines, steroids, mucolytics syrups, anti-histamines, expectorants etc)/ Using frequent nebulizations/ Using injectable Aminophyllines. 1
Doctors who score 2 or 1 (IN > 50% of their Asthma prescriptions) will be invited to attend CHAMPS.

8. Intervention Study Group Control group Attend CHAMPS
Do not Attend CHAMPS
Both fill in a pre and a post workshop questionnaire on the day of CHAPMS
Intervention
Both keep a prescription record for 1 month after the training programme

9. Results:-Outcome of the enrollment process
Screening calls to 907 doctors
118 (12%) agreed to participate and received prescription pads
52 (44%) gave us the recorded prescription pads
44 (84.6%) Doctors fulfilled the inclusion criteria
22-Control group
22-Study Group
Out of the 22 in study group, only 13 came for the training
1 dropped out after the training leaving only 12 in the study group.

10. Reason for poor outcomes of the prescription records from enrolled doctors

11. Conclusion
It is a real world challenge to enroll primary care doctors in a randomized controlled study involving them keeping prescription records and attending a training on Asthma.
We need alternate, more simple methods to evaluate the impact of our training programmes.

12. Discussion
Despite a stringent telephonic follow up and visits by the study team, it has been difficult to get doctors to participate in this research study.
Despite we having arranged for the travel of the doctors and getting the programme CME points, the target audience who is actually in need of this practice up gradation showed a very poor attendance.
The policy making bodies for practicing doctors needs to initiate and set up systems to ensure knowledge and practice up-gradation.