Standard versus patient-centred asthma education in the emergency department: a randomised study Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK The Influence of Structured Information and Monitoring on the Outcome of Asthma Treatment in Primary Care: A Cluster Randomized Study Effectiveness of pharmacist intervention for asthma control improvement Self-management support in "real-world" settings: an empowerment-based intervention. The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes Short-term effectiveness of an asthma educational program: results of a randomized controlled trial. Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial Promoting Adherence The role of the asthma nurse in treatment compliance and self-management following hospital admission. Self-treatment of asthma: possibilities and perspectives from the practitioner's point of view. A randomized controlled trial of self-management education for asthma patients in the emergency department. Evaluation of an individualised asthma programme directed at behavioural change A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study. A Randomized, Controlled Study to Evaluate the Role of an In-Home Asthma Disease Management Program Provided by Respiratory Therapists in Improving Outcomes and Reducing the Cost of Care
High re-attendance rates are common after asthma emergency department ( ED ) care . Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain . The present study aim ed to compare the effectiveness of patient-centred education ( PCE ) and st and ard asthma patient education on ED re-attendance . A r and omised controlled trial was conducted at two inner-city Australian teaching hospitals ’ EDs , where patients received either st and ard patient education ( SPE ) or PCE . Both groups received a six-topic curriculum . However , PCE patients reordered the topics according to their own priority and thus controlled the order of education . In total , 146 adult patients presenting to EDs with acute asthma were enrolled . After 4 months , ED re-attendance decreased from 22 to 12 % in the PCE group and remained unchanged in the SPE group ( between group odds ratio 0.4 , 95 % confidence interval ( 0.2–1.1 ) ) . In 78 patients discharged after ED care , the PCE group had fewer re-attendances after 4 and 12 months ( 0.3 ( 0.1–0.9 ) and 0.3 ( 0.1–0.8 ) , respectively ) . PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months ( 0.1 ( 0.0–0.7 ) and 0.2 ( 0.0–0.6 ) , respectively ) . A trend of better asthma control was evident , with a reduction in activity limitation . In conclusion , patient-centred education offers promise as a brief education process in the emergency department . However , a large multicentre trial of patient-centred education is required BACKGROUND Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation . This study reports clinical outcomes and quality of life from a community based project investigating white European ( W/E ) and Indian subcontinent ( ISC ) ethnic groups with asthma living in deprived inner city areas of Birmingham , UK . METHODS Six hundred and eighty nine asthmatic subjects ( 345 W/E , 344 ISC ) of mean ( SD ) age 34.5 ( 15 ) years ( range 11–59 ) and mean forced expiratory volume in one second ( FEV1 ) of 80 % predicted were interviewed in English , Punjabi , Hindi , or Urdu . Subjects r and omised to the active limb of a prospect i ve , open , r and omised , controlled , parallel group , 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up ( active intervention ) . Control groups were seen only at the beginning and end of the study . Urgent or emergency interactions with primary and secondary health care ( clinical outcomes ) and both cross sectional and longitudinal data from an Asthma Quality of Life Question naire ( AQLQ ) were analysed . RESULTS Clinical outcomes were available for 593 subjects . Fewer of the active intervention group consulted their GP ( 41.8 % versus 57.8 % , odds ratio ( OR ) 0.52 ( 95 % CI 0.37 to 0.74 ) ) or were prescribed antibiotics ( 34.9 % versus 51.2 % , OR 0.51 ( 95 % CI 0.36 to 0.72 ) ) , but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits . Active intervention reduced the number of hospital admissions ( 10 versus 30 ) , GP consultations ( 341 versus 476 ) , prescriptions of rescue oral steroids ( 92 versus 177 ) , and antibiotics ( 220 versus 340 ) , but again significant improvements by ethnicity only occurred in the active W/E group . AQLQ scores were negatively skewed to the higher values ; regression analysis showed that lower values were associated with ISC ethnicity . Longitudinal changes ( for 522 subjects ) in the mean AQLQ scores were small but statistically significant for both ethnic groups , with scores improving in the active and worsening in the control groups . CONCLUSIONS Active intervention only improved clinical outcomes in the W/E group . AQLQ scores , although lower in the ISC group , were improved by active intervention in both ethnic groups Background : In clinical trials of asthma , the outcomes are often good , but when the same treatment regimens are implemented in primary care , equally good results are not obtained . Objective : To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control . Methods : 141 patients from 19 primary care centres were studied . The centres were r and omised to a st and ard care group or to an intervention group . The intervention group received structured written and oral information about asthma and asthma medication , and were instructed to keep an asthma diary . The primary outcome was asthma control as assessed by the Asthma Control Question naire . Secondary outcomes were costs of asthma medication , the Mini Asthma Quality of Life Question naire score and lung function . Results : Asthma Control Question naire score changes differed between the study groups ( p < 0.05 ) . In the intervention group , these changes ( M = –0.45 ) in asthma control were close to clinical significance ( minimal important difference ≈0.5 ) . Both groups improved in disease-specific quality of life scores . For the intervention group , which changed the most ( p < 0.05 ) , the change exceeded the threshold for the minimal important difference ( 0.5 ) . The costs of medications increased significantly in the intervention group , where adjustments of medication were made more often than in controls . Conclusion : Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to st and ard care Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients OBJECTIVE This study examined the impact of a 6-month , empowerment-based diabetes self-management support ( DSMS ) intervention on clinical outcomes , self-care behaviors , and quality of life ( QOL ) compared to a 6-month control period . METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes . Baseline , 6-month , and 12-month assessment s measured A1C , weight , body mass index ( BMI ) , blood pressure , lipids , self-care behaviors , and QOL . During the control period , participants received weekly educational newsletters . During the intervention period , participants attended weekly DSMS groups as frequently as they needed . Sessions were guided by participants ' self-management questions and concerns , and also emphasized experiential learning , coping , problem-solving , and goal - setting . RESULTS The control period found significant improvements for diastolic BP ( p<0.05 ) , serum cholesterol ( p<0.001 ) , following a healthy diet ( p<0.01 ) , and monitoring blood glucose ( p<0.01 ) . The intervention period found significant additional improvements for A1C ( p<0.001 ) , weight ( p<0.05 ) , BMI ( p<0.05 ) , and LDL ( p<0.001 ) . Compared to the control period , participation in the intervention led to a significant reduction in A1C ( p<0.01 ) . CONCLUSION Findings suggest that an empowerment-based , DSMS intervention is promising for improving and /or maintaining diabetes-related health , particularly A1C . PRACTICAL IMPLICATION S Incorporating empowerment principles in DSMS interventions may be useful for supporting patients ' self-management efforts in " real-world " setting Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes Asthma educational programs have been shown to reduce the use of emergency room , frequency of severe asthma attacks and hospitalization . However , its effectiveness in other morbidity parameters and on quality of life has yet to be fully understood . This prospect i ve r and omized control trial evaluated the effectiveness of a patient education program in 77 asthmatics according to " Teach Your Patients About Asthma : A Clinicians Guide " ( 1992 ) . Forty asthmatic patients were r and omly allocated to Group A ( usual treatment ) and 37 to Group B ( usual treatment plus a patient education program ) . The effectiveness of the educational program was evaluated by comparing morbidity outcomes at baseline and 3 months after initial evaluation . At enrolment , the two groups were not different with regard to age , sex , smoking , asthma severity atopy , FEV1 , symptom-free days , use of rescue salbutamol and quality of life . Three months later , subjects in Group B showed a significant improvement in the overall quality of life ( p < 0.01 ) and in the " Symptoms"domain ( p < 0.01 ) . None of the other parameters ( use of rescue salbutamol , symptom-free days , days absent from work or school , FEV1 ) showed any significant change . After stratification for asthma severity , only subjects with moderate-to-severe asthma showed a significant improvement inthe overall quality of life ( p < 0.05 ) and in the " Symptoms " ( p < 0.01 ) and ' Activities " ( < 0.05 ) domains . Moreover , in subjects with moderate-to-severe asthma FEV1 value at the 3rd month of follow-up was higher in Group B than in Group A ( p < 0.05 ) . In conclusion , the educational program improved the quality of life in asthratic subjects , mainly in patients with moderate-to-severe asthma Background : Functional breathing disorders may complicate asthma and impair quality of life . This study aim ed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing . Methods : 33 adult patients aged 17–65 with diagnosed and currently treated asthma and Nijmegen question naire scores ⩾23 were recruited to a r and omised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control . The main outcome measures were asthma specific health status ( Asthma Quality of Life question naire ) and Nijmegen question naire scores Results : Of the 33 who entered the study , data were available on 31 after 1 month and 28 at 6 months . The median ( interquartile range ) changes in overall asthma quality of life score at 1 month were 0.6 ( 0.05–1.12 ) and 0.09 ( −0.25–0.26 ) for the breathing retraining and education groups , respectively ( p=0.018 ) , 0.42 ( 0.11–1.17 ) and 0.09 ( −0.58–0.5 ) for the symptoms domain ( p=0.042 ) , 0.52 ( 0.09–1.25 ) and 0 ( −0.45–0.45 ) for the activities domain ( p=0.007 ) , and 0.50 ( 0–1.50 ) and −0.25 ( −0.75–0.75 ) for the environment domain ( p=0.018 ) . Only the change in the activities domain remained significant at 6 months ( 0.83 ( −0.10–1.71 ) and −0.05 ( −0.74–0.34 ) , p=0.018 ) , although trends to improvement were seen in the overall score ( p=0.065 ) , the symptoms domain ( p=0.059 ) , and the environment domain ( p=0.065 ) . There was a correlation between changes in quality of life scores and Nijmegen question naire scores at 1 month and at 6 months . The number needed to treat to produce a clinical ly important improvement in health status was 1.96 and 3.57 at 1 and 6 months . Conclusion : Over half the patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing show a clinical ly relevant improvement in quality of life  following a brief physiotherapy intervention . This improvement is maintained in over 25 % 6 months after the intervention This study compared the effects of a the oretically focused audiotape and a st and ard educational booklet on asthma preventive medication adherence and other asthma outcomes .  Forty-six adult asthmatics were r and omly assigned to receive either an experimental audiotape incorporating components of protection motivation theory , a st and ard asthma management booklet , both , or no educational material s. Outcomes were assessed at baseline , 3 months , and 6 months . Mean pharmacy-verified adherence improved 15 % to 19 % in the intervention groups and declined 22 % in the control group at 6 months . Using analysis of covariance ( ANCOVA ) to control for baseline adherence , these changes were significant between the control and booklet group ( t = 2.47 ; p = .02 ) and between control and combined group ( t = 2.07 ; p = .04 ) . Providing a minimal educational intervention can have a beneficial effect on asthma medication adherence that persists at least 6 months Effective self-management and treatment compliance is important in achieving good symptom control in asthma . The aim of this study was to determine whether asthma nurse intervention during hospital admission could increase knowledge and improve self-management and whether this would influence the number of emergency call-out visits by Genera Practitioners ( GPs ) and hospital re-admissions . Patients with acute asthma ( n=80 ) were assessed by the asthma nurse within 24 h of admission using a British Thoracic Society ( BTS ) guideline -based question naire . Main outcome measures were : know edge of inhalers , self-management plans , peak flow monitoring , recognition of worsening symptoms and appropriate emergency action , Following r and omization , half received nurse intervention during hospitalization . All received a follow-up question naire 6 weeks post-discharge and again at 6 months ( response rates 86 % and 81 % respectively ) . GPs were contacted by postal question naire after 4 months . Question naire responses indicated an increase in knowledge in the intervention group , along with an ability to identify appropriate action on worsening symptoms . Emergency GP call-outs were more frequent in the control group in the 4 months post-discharge . Hospital re-admission rates were similar in both groups . Asthma nurse intervention appeared to increase knowledge of asthma management , maintained throughout the study period , but had no significant impact on reducing re-admissions to hospital OBJECTIVES  Self-management  of asthma is becoming more and more widespread . The implementation of this treatment strategy requires changes in the role and attitude of the GP . These changes may be hindered by obstacles both expected and experienced . As self-treatment of asthma is more common in the UK , comparison between UK and Dutch GPs provides a good opportunity to identify possible obstacles in general practice to the implementation of self-treatment of asthma with inhaled corticosteroids . METHODS We carried out a qualitative descriptive study with self-administered question naires and interviews . Question naires were sent to 500 r and omly selected Dutch GPs . Interviews were held with 20 Dutch and 25 British GPs in order to acquire more in-depth information . The outcome measures were attitude towards , knowledge regarding and experiences with self-treatment of asthma ; organizational requirements ; and expectations of consequences of self-treatment in general practice . RESULTS The Dutch and British GPs investigated have a positive attitude towards self-treatment of asthma . Though knowledge about self-treatment is present among a majority of the GPs , self-treatment by patients is not yet as common in The Netherl and s as it is in the UK . Nineteen per cent of the Dutch GPs had experience with a written peak-flow-based self-treatment plan related to the usage of inhaled steroids . According to our findings , present expected obstacles are probably mainly of the organizational kind , such as the availability of time , money and material s. CONCLUSIONS There is a positive attitude towards the implementation of self-treatment plans in general practice , but problems relating to certain identified obstacles need to be addressed . There is a need to define which patients might profit from self-treatment , and further proof of both the clinical effectiveness and the cost-effectiveness of self-treatment needs to be acquired STUDY OBJECTIVE Patients using the emergency department ( ED ) for asthma may benefit from self-management education . Our goal is to test an educational intervention in 296 asthma ED patients . METHODS This was a r and omized controlled trial with concealed allocation . Controls received instruction from an asthma knowledge test , peak flowmeter training , and asthma brochures . Intervention patients received these plus a self-management workbook , a behavioral contract , inhaler training , and telephone reinforcements . The main outcome was change in Asthma Quality of Life Question naire ( AQLQ ) score at 8 weeks ( a change of 1.5 is a marked clinical ly important difference ) . Secondary outcomes were repeated ED visits and change in AQLQ scores at 4 , 12 , and 16 weeks and 1 year . RESULTS Mean age of patients was 44 years , and 93 % had the 8-week follow-up .  Enrollment AQLQ scores were comparable and increased at 8 weeks by more than a marked clinical ly important difference in both groups . For controls , the change in score was 1.95 ( 95 % confidence interval [ CI ] 1.74 to 2.16 ; P<.001 ) , for intervention patients the change in score was 1.83 ( 95 % CI 1.64 to 2.03 ; P<.001 ) , and the difference between groups was 0.11 ( 95 % CI -0.17 to 0.40 ; P=.43 ) . Patients who improved more ( ie , change was above the group mean ) were more likely to be high school graduates ( odds ratio=1.9 ; 95 % CI 1.0 to 3.8 ) , previous or current smokers at enrollment ( odds ratio=2.2 ; 95 % CI 1.3 to 3.5 ) , and to have been admitted to the hospital from the ED ( odds ratio=1.7 ; 95 % CI 1.0 to 2.8 ) . Similar variables were associated with AQLQ outcomes in hierarchic analyses during 16 weeks . Repeated ED visits occurred for 12 % of patients at 8 weeks and in multivariate analysis were associated with no hospitalization for the index ED visit , difficult access to outpatient care , and previous ED visits . Fewer patients ( 16 % ) had an ED visit at 12 weeks compared with a similar time before enrollment ( 36 % ) . CONCLUSION Patients in both groups had marked sustained improvements in clinical status 16 weeks after an ED visit for asthma . A self-management education intervention delivered in the ED and reinforced by telephone was successfully implemented , with high retention rates , but did not provide incremental benefit for quality of life and short-term repeated ED visit outcomes An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment , despite adequate medical treatment . Mild-to-moderate asthma patients ( n=23 ) were r and omly assigned to a programme or waiting list condition . Outcome measures were : McMaster Asthma Quality of Life Question naire , Asthma Symptom Checklist , Negative Emotionality Scale , Knowledge , Attitude and Self-Efficacy Asthma Question naire , Adherence Scale , and peak flow measurements . Both groups were evaluated at three consecutive moments , each separated by 3 months ; the programme was delivered between the first two evaluations . At onset the patient received a workbook containing information , exercises and homework assignments . Psycho-education , behavioural and cognitive techniques were introduced during six 1‐h individual sessions . Compared with controls the programme group reported less symptoms ( obstruction , fatigue ) , better quality of life ( activity , symptoms , emotions ) , decreased negative affectivity , and increased adherence , immediately after finishing the programme and at 3 months follow-up . All three cognitive variables ( knowledge , attitude towards asthma , self-efficacy ) and day and night peak flow ratings improved in the programme group but not in the waiting list group . Participation in an individualised programme result ed in improvement of asthma morbidity , and asthma-related behaviour and cognitions , in subjects reporting symptoms and impairment despite adequate medical therapy BACKGROUND Poor adherence to asthma treatment is a well-recognised challenge and is associated with increased morbidity , mortality and consumption of health care re sources . This study examined the impact of receiving a daily text message reminder on one 's cell phone on adherence to asthma treatment . METHODS A total of 26 subjects aged 18 - 45 years , with a clinical history of asthma and a positive methacholine challenge test ( PD(20)<or=4micromol ) were r and omised to receive , or to not receive , a daily short message service ( SMS ) reminder on their cell phone to take their anti-asthmatic medication . Inhaled corticosteroids to last for eight weeks and a prescription for four additional weeks were given to the subjects . The primary outcome was adherence to asthma treatment . Secondary outcomes were reimbursement of asthma medication , and change in exhaled nitric oxide levels , lung function , and airway responsiveness . RESULTS The absolute difference in mean adherence rate between the two groups after 12 weeks was 17.8 % , 95 % CI ( 3.2 - 32.3 % ) , p=0.019 . No significant differences were observed between the two r and omisation groups for the secondary outcomes . CONCLUSION Daily text message reminders are already after a short period of observation associated with increased adherence to anti-asthmatic medication Background and purpose . Asthma management programs ( AMP ) may reduce costs and improve outcomes in patients with moderate to severe asthma . However , it is not known which personnel are best able to deliver such interventions and what setting s are most effective . The purpose of this study was to compare the effects of an in-home AMP provided by respiratory therapists ( RTs ) to an AMP provided by nurses ( RNs ) and to usual care ( UC ) provided in physician offices or clinics . Methods . Subjects ( age 18–64 ) who had been admitted to the emergency department ( ED ) or hospital for acute asthma exacerbation were r and omized to three groups : AMP-RT , AMP-RN or UC . The AMP groups received five ( 5 ) weekly home visits to provide assessment and instruction ; the UC group was instructed to return to their physician for routine follow-up . Outcomes assessed at 6 months included hospitalizations , in patient days , hospitalization cost , ED visits and cost , clinic visits , pulmonary function , symptoms , health related quality of life ( HRQOL ) , asthma episode self-management score ( AESM ) , environmental assessment , and patient satisfaction ( PS ) . Variables were compared using ANOVA with a Neuman-Keuls follow-up for multiple comparisons using an intent-to-treat approach . Results . Upon enrollment , ( n = 159 ) there were no differences ( p > . 05 ) between groups for age , gender , pulmonary function or HRQOL ( SF-36 and St. Georges Respiratory Question naire – SGRQ ) . At 6 months , both AMP groups ( AMP-RN n = 54 ; AMP-RT n = 46 ) had significantly fewer ( p < 0.05 ) hospitalizations and in-patient days , lower hospitalization costs , and greater HRQOL physical component summary change scores ( PCS ) and PS than UC ( n = 59 ) . AMP-RT also had greater PEFR , SGRQ Total and SGRQ Symptoms change scores when compared to UC and significantly better AESM and PS scores as compared to AMP-RN and UC . Conclusions . An in-home asthma management program can be effectively delivered by respiratory therapists and may reduce hospitalizations , in-patient days , cost and improve measures of HRQOL and PS in a population prone to asthma exacerbation
OBJECTIVES The purpose of this study is to up date previous systematic review s of interventions targeting asthma self-care in adults with asthma , and to use meta-regression to examine the association between the use of specific behavior change techniques and intervention effectiveness .