A randomized controlled trial of an information booklet for hypertensive patients in general practice. The relative impact of health education for low- and high-risk patients with hypertension. Effects of diet and exercise interventions on control and quality of life in non-insulin-dependent diabetes mellitus Effects of instruction by practice assistants on inhaler technique and respiratory symptoms of patients. A controlled randomized videotaped intervention study. A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Working Group for the Study of Patient Self-Management of Oral Anticoagulation. Asthma self-management education program by home monitoring of peak expiratory flow. Effects of psychological therapy on pain behavior of rheumatoid arthritis patients. Treatment outcome and six-month followup. A comparison of lay-taught and professional-taught arthritis self-management courses. Prevention of amputation by diabetic education. Health outcomes of two telephone interventions for patients with rheumatoid arthritis or osteoarthritis. Effects of home blood pressure measurement on long-term BP control. Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for Type 1 (insulin-dependent) diabetes mellitus in Moscow—blood glucose versus urine glucose self-monitoring CONTROLLED EVALUATION OF THE EFFECTS OF PATIENT EDUCATION ON ASTHMA MORBIDITY IN GENERAL PRACTICE Pain management in rheumatoid arthritis patients. A cognitive-behavioral approach. Community-based education classes for hypertension control. A 1.5-year randomized controlled trial. Peak flow based asthma self-management: a randomised controlled study in general practice. British Thoracic Society Research Committee. Controlled trial evaluation of an asthma education programme for adults. Single-blind randomized controlled trial of an educational booklet for patients with chronic arthritis. Influence of Small-Group Education Sessions on Glucose Homeostasis in NIDDM Outcomes of self-help education for patients with arthritis. Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk A Controlled Trial on the Effects of Patient Education in the Treatment of Insulin-dependent Diabetes Promoting self-care in clients with arthritis. An educational and behavioral approach toward increasing patient activation in hypertension management EVALUATION OF A STRUCTURED TREATMENT AND TEACHING PROGRAMME ON NON-INSULIN-DEPENDENT DIABETES Evaluation of a community arthritis program in Australia: dissemination of a developed program. A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication. The cost and effectiveness of an education program for adults who have asthma Diabetes support groups improve health care of older diabetic patients. Patient education in arthritis: randomized controlled trial of a mail-delivered program. Prospective controlled evaluation of the effect of a community based asthma education centre in a multiracial working class neighbourhood. Development and evaluation of an adult asthma self-management program: Wheezers Anonymous. Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. Five-year blood pressure control and mortality following health education for hypertensive patients. Group therapies for rheumatoid arthritis. A controlled study of two approaches. Health outcomes among African American and Caucasian adults following a randomized trial of an asthma education program. Evaluation of a structured treatment and teaching programme on hypertension in general practice. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. A Randomized Study of the Effects of a Home Diabetes Education Program A Pain Education Program for chronic cancer pain patients: follow-up results from a randomized controlled trial A randomized trial to improve self-management practices of adults with asthma. A controlled trial of two forms of self-management education for adults with asthma. Knowledge in patients with rheumatoid arthritis: a longer term follow-up of a randomized controlled study of patient education leaflets. A controlled trial of a behavioral and educational intervention following coronary artery bypass surgery. Usefulness of a systemic hypertension in-hospital educational program. DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. The impact of health education on frequency and cost of health care use by low income children with asthma. Evaluation of two educative models in a primary care hypertension programme. Coordinated individual education with an arthritis passport for patients with rheumatoid arthritis. Long-term patient self-management of oral anticoagulation. A 5-year follow-up of a controlled trial of an arthritis education programme. Randomised comparison of guided self management and traditional treatment of asthma over one year Group education for people with arthritis. The impact of diabetes education and peer support upon weight and glycemic control of elderly persons with noninsulin dependent diabetes mellitus (NIDDM). Stress-Management Training for Essential Hypertension: A Controlled Study Stress management and mutual support groups in rheumatoid arthritis. A controlled evaluation of arthritis education. Problem oriented participatory education in the guidance of adults with non-insulin-treated type-II diabetes mellitus. Impact of self-management education on the functional health status of older adults with heart disease. The Diabetes Education Study: A Controlled Trial of the Effects of Diabetes Patient Education Intensified antihypertensive therapy is associated with improved survival in type 1 diabetic patients with nephropathy Health education program effects on the management of hypertension in the elderly. Can the provision of information to patients with osteoarthritis improve functional status? A randomized, controlled trial.
A r and omized controlled trial of an information and medical record booklet design ed to improve patient underst and ing and participation in the management of hypertension was conducted in six inner London general practice s. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure , but the study group scored significantly higher on knowledge about hypertension and its management . However , the difference between the two groups was small , possibly because both groups started with a high level of underst and ing about hypertension and its management . In addition , the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory , and that there was little need for improvement . Nevertheless , the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice Abstract An experimental study was carried out to test and analyze the effects of an educational program on a group of hypertensive patients , comparing those with known higher risks of stroke and heart attack , e.g. , secondary organ damage , with a group whose risks were relatively lower . Specific interventions have been shown to be differentially effective on specific patient behaviors ( e.g. , compliance with therapy )  and on blood pressure control for both higher- and lower-risk patients in most of the experimental groups . Such findings emphasize the importance of tailored educational approaches , not only for a hypertensive population , but , more importantly , for patients who are known to have more difficulty achieving their blood pressure control and who are at higher risk of morbidity and mortality , i.e. , patients who have secondary organ damage , have been previously hospitalized for hypertension , or are black males under 50 years of age Evidence suggests that diet and exercise are associated with improved glucose tolerance for patients with non-insulin-dependent diabetes mellitus ( NIDDM ) . Seventy-six volunteer adult patients with NIDDM were each assigned to one of four programs : 1 ) diet , 2 ) exercise , 3 ) diet plus exercise , or 4 ) education ( control ) . Each program required ten weekly meetings . Detailed evaluations were completed prior to the program and after three , six , 12 , and 18 months . Evaluations included various psychosocial measures , measures of the quality of life , and fasting blood glucose , glycosylated hemoglobin , and relative weight determinations . Of the 76 original participants , 70 completed the 18-month follow-up study . At 18 months , the combination diet- and -exercise group had achieved the greatest reductions in glycosylated hemoglobin measures . In addition , this group showed significant improvements on a general quality of life measure . These improvements were largely uncorrelated with changes in weight . The authors conclude that the combination of dietary change and physical conditioning benefits NIDDM patients , and that the benefits may be independent of substantial weight loss BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea CONTEXT Control of oral anticoagulation therapy has been reported to often be inadequate . Previous retrospective investigations suggest that patients ' self-adjustment of oral anticoagulants may lead to improved control . OBJECTIVE To investigate the effects of patients ' self-management of oral anticoagulation therapy on accuracy of control and measures of treatment-related quality of life . DESIGN R and omized , single-blind , multicenter trial . SETTING AND PARTICIPANTS A total of 179 patients receiving long-term oral anticoagulation treatment were enrolled at 5 referral centers in Germany . INTERVENTION Patients were r and omized to an oral anticoagulation self-management group based on a structured treatment and teaching program and international normalized ratio ( INR ) self-monitoring . The control group received conventional care as provided by family physicians , including referral to specialists if necessary . MAIN OUTCOME MEASURES Deviation of INR values from the individual INR target range ( squared ) and the 5 categories of treatment-related quality of life . RESULTS Deviation of INR value from the mean of the INR target range was significantly lower in the intervention group at 3-month ( squared INR deviation , 0.59 vs 0.95 ; P<.001 ) and 6-month follow-up ( 0.65 vs 0.83 ; P=.03 ) compared with the control group . Also , the intervention group had INR values within the target range more often ( repeated measurement analysis for categorical data , P=.006 ) . The results were mainly due to less frequent suboptimal INR values in the intervention group ( 32.8 % vs 50.0 % [ P=.03 ] at 3-month , and 33.7 % vs 48.2 % [ P=.08 ] at 6-month follow-up ) . Treatment-related quality -of-life measures , especially treatment satisfaction scores , were significantly higher in the intervention group compared with controls . CONCLUSIONS An anticoagulation education program that includes self-management of anticoagulation therapy results in improved accuracy of anticoagulation control and in treatment-related quality -of-life measures . Further studies are needed to describe whether the program will reduce risk of bleeding or thromboembolism A prospect i ve controlled trial of home monitoring of peak expiratory flow rate ( PEFR ) was conducted to determine the usefulness of an objective measure of lung function in association with an education program and a medication self-management plan in reducing morbidity in adult patients with asthma . Thirty-five patients managed themselves , using peak flow readings as the basis for the therapeutic plan coupled with educational intervention , whereas 35 control patients  used symptoms and spirometric data for following physicians ' treatment plans . After a 6-mo study period , patients in the experimental group showed statistically significant improvements in morbidity parameters ( days lost from work , acute asthma attacks , days on antibiotic therapy , physician consultations , and emergency room admissions for asthma ) , increases in FVC , FEV1 , and FEV1/FVC , mean PEFR and mean morning PEFR , decrease in percentage of the mean PEFR amplitude , and a reduction in the use of inhaled beta-agonists , oral theophylline , and oral prednisone .  Although improvements in some of these parameters were also found in the control group , they did not reach the levels of significance obtained in the experimental group . The personal use of an objective measure of lung function in association with a medication self-management plan leads to improvement in the patient 's condition A r and omized clinical trial was performed to evaluate a psychological treatment intervention and a social support program , compared with a control program in which no adjunct treatment was rendered , and their effects upon pain behavior , affect , and disease activity of 53 patients with rheumatoid arthritis . The psychological intervention produced significant reductions in patients ' pain behavior and disease activity at posttreatment . Significant reductions were also observed in trait anxiety at posttreatment and 6-month followup . Relaxation training may have been the most important component of the psychological intervention . The social support program produced a significant reduction in trait anxiety only at posttreatment . This is the first well-controlled study to demonstrate reduced pain behavior , disease activity , and trait anxiety following psychological treatment One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals This prospect i ve r and omized study evaluated the influence of a simple education program on the incidence of lower extremity amputation in diabetic patients . Two hundred three patients were r and omized into two groups : Group 1 , education ( 103 patients , 203 limbs ) and Group 2 ,  no education ( 100 patients , 193 limbs ) . There were no significant differences in medical management or clinical risk factors between the two groups . The amputation rate was three times higher in Group 2 ( 21 of 177 limbs versus 7 of 177 limbs ; p less than or equal to 0.025 ) , the ulceration rate was three times higher in Group 2 ( 26 of 177 limbs versus 8 of 177 limbs ; p less than or equal to 0.005 ) , and there was no difference in the overall incidence of infection ( 2 of 177 limbs ) . Overall success in Group 1 was highly significantly different from Group 2 ( 160 of 177 limbs versus 128 of 177 limbs ; p less than or equal to 0.0005 ) . This study demonstrated that a simple education program significantly reduced the incidence of ulcer or foot and limb amputation in diabetic patients OBJECTIVE The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis ( RA ) or osteoarthritis ( OA ) , compared with usual care , were assessed . METHODS A 3-group , r and omized , controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales ( AIMS 2 ) as the outcome measure . RESULTS Analyses of covariance showed that the AIMS 2 total health status of the treatment counseling group ( effect size = 33 , P < 0.01 ) , but not the symptom monitoring group ( effect size = 0.21 , P = 0.10 ) , was significantly improved , compared with usual care , for both RA and OA patients . The specific types of benefits differed significantly between RA and OA patients . The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced ( P < 0.01 ) . CONCLUSION Telephone contact using the treatment counseling strategy produced significant , but different , health status benefits for RA and OA patients . The symptom monitoring strategy produced modest benefits This research reports level of blood pressure control and ability to maintain newly discovered hypertensives in a municipal hospital setting by use of family- and self-monitored home blood pressure units .  Three hundred ninety-six patients were r and omized into family- and self-monitored blood pressure groups and a control group . Findings indicate that the use of either self- or family-read cuffs is effective in the first six months of treatment in lowering blood pressures . The data are suggestive of a beneficial effect of the use of cuffs for up to 18 months ; however , with additional time in the study , no differences in the level of blood pressure control could be demonstrated between groups . The use of family-monitored blood pressure cuffs produces a lower drop-out rate than does the use of no cuff . The effect on drop outs is substantial for the first year of treatment , but beyond 12 months , the family-read cuff is also more effective than no cuff in reducing drop outs Summary In a prospect i ve controlled trial the effects of a 5-day in-patient treatment and teaching programme for Type 1 ( insulin-dependent ) diabetes mellitus on metabolic control and health care costs were studied in Moscow . Two different intervention programmes were compared , one based upon urine glucose self-monitoring ( UGSM , n = 61 ) and one using blood glucose selfmonitoring ( BGSM , n = 60 ) . Follow-up was 2 years . A control group ( n = 60 ) continued the st and ard treatment of the Moscow diabetes centre and was followedup for 1 year . Costs and benefits with respect to hospitalizations and lost productivity ( according to average wage ) were measured in November 1992 roubles ( Rb . ) , with respect to imported drugs and test strips in 1992 German marks ( DM ) . In the intervention groups there were significant decreases of HbA1 values [ UGSM : 12.5 % before , 9.4 % after 1 year , 9.2 % after 2 years ( p < 0.0001 ) ; BGSM : 12.6 % before , 9.3 % after 1 year , 9.2 % after 2 years ( p < 0.0001 ) compared to no change in the control group ( 12.2 % before , 12,3 % after 1 year ) ] , and of the frequency of ketoacidosis . The frequency of severe hypoglycaemia was comparable between the UGSM ( 10 cases during 2 years ) , BGSM ( 10 cases during 2 years ) , and the control group ( 8 cases during 1 year ) . In the combined intervention groups , there were significant decreases of hospital days per patient per year ( 12.1 during the year before , 1.0 year one after , 3.6 year two after , p < 0.005 ) , and of additional sick leave days ( 16.6 during the year before , 2.4 year one , 7.8 year two after , p < 0.01 ) , whereas these parameters remained unchanged in the control group . The initial costs of the intervention were outweighed by this subsequent reduction in hospitalizations and lost productivity . Net savings totalled up to 14400 Rb./patient within 2 years . Patients of the intervention groups were told to discontinue drugs which were not indicated and /or ineffective ( clofibrate , pentoxifylline , calcium dobesilate ) . This caused estimated average savings of DM 240 per patient per year . Costs of test strips for UGSM were DM 180 per patient per year ; for BGSM they were estimated to lie between DM 370 and DM 550 per patient per year , depending on the frequency of measurements . In conclusion , the intervention led to an improvement of metabolic control and saved re sources for health care by reducing hospitalizations and sick leave days . When UGSM is used , costs of test strips are approximately outweighed by discontinuing ineffective drugs Two different patient education programmes for asthma in general practice were evaluated in a controlled trial . Knowledge , self management , and morbidity due to asthma were assessed in 339 patients by means of a question naire . One group then received a maximum education programme , a second group received a limited education programme , and a third acted as a control group .  274 patients were reassessed after one 1 year . In both the intervention groups , underst and ing of asthma was greater after the trial . Only in the maximum intervention group was a significant improvement in knowledge of asthma shown . Neither group showed any change in self-management ability or asthma morbidity that differed significantly from changes in the control group . These simple informational education programmes were ineffective when applied to a general practice population . Further studies of factors affecting attitudes , beliefs , and actions are needed to improve the advice and support given to asthma patients To examine the effectiveness of a  cognitive-behavioral pain management program for patients with rheumatoid arthritis , three patient groups were studied : a cognitive-behavioral group ( CB ) , an attention-placebo group , and a control group .  The CB group received a comprehensive , 12-month pain management program that taught coping strategies such as problem-solving techniques , relaxation training , strategies for attention diversion , and training in family dynamics and communication . Dependent measures included pain , coping strategies , psychological status , functional status , and disease status . Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies . Specifically , the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain . The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis Community-based hypertension control is important for primary prevention of cardiovascular disease . In this study , untreated men and women aged 35 to 69 years were r and omly assigned to an  intervention ( n=56 ) or control ( n=55 ) group in a 1.5-year community-based education program .  Subjects had no evidence of hypertensive end-organ defects and had screening blood pressures of 140 to 179 mm Hg systolic and /or 90 to 109 mm Hg diastolic , with no difference in mean blood pressure between groups ( 148 to 150 mm Hg for mean systolic and 83 to 84 mm Hg for mean diastolic pressures ) . The intervention group took four education classes in the first 6 months and four classes during the next year , and the control group took two classes . Health education focused on reduced dietary sodium and increased milk intake , brisk walking , and , if necessary , reduction of alcohol and sugar intakes . Antihypertensive medication was started less often in the intervention than in the control group at 1.5 years ( 9 % versus 24 % , P < .05 ) . Mean systolic pressure was 5 to 6 mm Hg less in the intervention than in the control group at both 6 months and 1.5 years ( P < .05 ) , with or without inclusion of those subjects who began antihypertensive medication . Diastolic pressure and body mass index did not change significantly between groups . Urinary sodium excretion declined in the intervention but not in the control group ( differences between groups : P=.04 at 6 months and P=.07 at 1.5 years ) . According to a behavioral question naire , sodium reduction and milk increase were greater in the intervention than the control group ( sodium : P < .01 at 6 months and P=.08 at 1.5 years ; milk : P < .001 at 6 months and P < .01 at 1.5 years ) . Mean ethanol intake was reduced in the intervention but not the control group ( P=.04 at 1.5 years ) . This community-based hypertension control program was effective in reducing systolic pressure levels by nonpharmacological means during the first 6 months and maintaining the reduction for 1.5 years BACKGROUND --Peak flow based asthma self-management plans have been strongly advocated in consensus statements , but convincing evidence for the effectiveness of this approach has been largely lacking . METHODS --A r and omised controlled trial was conducted in 25 general practice s comparing an  asthma self-management programme  based on home peak flow monitoring and surgery review  by a general practitioner or practice nurse with a programme of planned visits for surgery review only over a six month period . RESULTS --Seventy two subjects ( 33 in the self-management group and 39 in the planned visit group ) completed the study protocol , but diary card data for at least three months were available on a total of 84 ( 39 in the self-management group and 45 in the planned visit group ) . Teaching self-management took longer than the planned visit review . In the self-management group home peak flow monitoring was felt to be useful by doctors and patients in 28 ( 85 % ) and 27 ( 82 % ) cases , respectively . There were no between group differences during the study period in terms of lung function , symptoms , quality of life , and prescribing costs . Only within the self-management group were improvements noted in disturbance of daily activities and quality of life . Possible explanations for these negative results include small numbers of subjects , the mild nature of their asthma , and inappropriate self-management strategies for such patients . CONCLUSIONS -- Rigid adherence to long term daily peak flow measurement in the management of mild asthma in general practice does not appear to produce large changes in outcomes . Self-management and the use of prescribed peak flow meters need to be tailored to individual circumstances BACKGROUND --To improve asthma control and reduce readmission rates through increased knowledge and the development of self management skills , a brief ( three hour ) adult education programme was developed . METHODS --The course was design ed to improve inhaler skills and to teach how to adjust drug doses according to peak flow ( PEF ) measurements and a treatment plan . It was evaluated in a r and omised controlled trial in 76 patients admitted to hospital for asthma by using question naires , spirometry , and home monitoring of PEF at entry and at five and 10 months after intervention . The question naire provided measures of knowledge about asthma , self management behaviour appropriate to asthma control , asthma symptom frequency and severity , and psychosocial disturbance attributable to asthma . RESULTS --During the 10 months observation period the readmission rate for the educated group was one seventh that of the control group and attendance at accident and emergency departments also decreased . No consistent differential improvements were observed in spirometric results , average PEF , or mean daily variability of PEF . Both groups showed improvements in measures of asthma knowledge , behaviour , symptoms , and psychosocial disturbances . However , the intervention group showed a significantly greater improvement in some measures of asthma knowledge and self management skills . CONCLUSION --Despite minimal effect on measures of airway function , substantial changes in illness behaviour and use of health care facilities can be achieved by a brief asthma education programme Consecutive new attendees at a rheumatology clinic were r and omly allocated to one of three groups . All groups received routine care , but one received no other intervention , one an educational booklet on arthritis and one the booklet plus instruction from a health professional . Prior to intervention , all groups had similar knowledge . Nottingham Health Profile ( NHP ) and Health Assessment Question naire ( HAQ ) score . After 6 weeks , the knowledge score was significantly increased in both groups given the booklet , but not in the control group . The group instructed by a health professional showed no greater increase than the group given the booklet alone . Increased knowledge was not associated with improved clinical status and no group showed a significant change in NHP or HAQ scores . Nearly all patients said they found the booklet useful In patients with non-insulin-dependent diabetes mellitus ( NIDDM ) , the influence of knowledge about their disease on the treatment and control of the disease is not clear . We evaluated the efficacy of educational group meetings with NIDDM patients on improving their knowledge of the disease and on disease management .  Fifty-one NIDDM patients were r and omly assigned to either intervention or control groups . The intervention group participated in courses of three weekly lessons presented by a physician , nurse , and dietitian once every 4 mo . The intervention and control groups were also followed once every 2 mo in the clinic by the same staff . Medical treatment remained unchanged during the study . After a 12-mo follow-up of the intervention group , no significant improvement in their knowledge of diabetes could be demonstrated . However , mean fasting and postpr and ial blood glucose levels and HbA1c improved significantly in comparison with the control goup . The same tendency was evident with the weight and lipoprotein profile . We conclude that educational group therapy can improve diabetes control in patients with NIDDM Behavioral and health status outcomes of an unreinforced , self-help education program for arthritis patients taught by lay persons were examined in 2 ways : a 4-month r and omized experiment and a 20-month longitudinal study . At 4 months , experimental subjects significantly exceeded control subjects in knowledge , recommended behaviors , and in lessened pain . These changes remained significant at 20 months . The course was inexpensive and well-accepted by patients , physicians , and other health professionals Abstract Objective : To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities . Design : R and omised controlled trial of personal health education given every four months . Setting : 18 general practice s in the greater Belfast area . Subjects : 688 patients aged less than 75 years and known to have had angina for at least six months ; 342 r and omised to receive education and 346 to no education .  Main outcome measures : Restriction of everyday activities , dietary habit , smoking habit , frequency of physical exercise ; blood pressure , body mass index , and serum total cholesterol concentration at entry to trial and after two years . Results : 317 in the intervention group and 300 in the control group completed the trial . At the two year review more of the intervention group ( 140 , 44 % ) reported taking daily physical exercise than the control group ( 70 , 24 % ) . The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity . No significant differences were found between the groups in smoking habit , systolic or diastolic blood pressure , cholesterol concentration , or body mass index . Conclusion : Despite having no significant effect on objective cardiovascular risk factors , personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities The effect of patient education on diabetic control in insulin-treated diabetic adults was studied in 77 subjects r and omized into two groups : intensive patient education ( group A ) and control ( group B ) . The subjects in group A received intensive patient instruction , both individually and in small groups , from a team of physicians , teaching nurses , and a dietitian . The patients in group B received a short instruction course consisting mainly of printed material . A highly significant improvement in diabetic control was observed in both groups immediately after the education programs , with gradual return to the original level during the following 3–6 mo . No difference was observed between the two groups in any of the measured parameters during the 18-mo investigation . Factors related to good control during the study included the length of school education , the quality of the control at the beginning of the study , and the high degree of self-confidence and lack of signs of anxiety in the psychological tests . The results demonstrate that the effects of educational programs are of limited value if they do not lead to permanent changes in attitudes and motivation , which are critical factors affecting long-term diabetic control Preliminary work regarding the development and pilot study of an individualized instructional program for rheumatoid arthritis clients is presented . The effect of the individualized instructional program was tested with 31 out patients . Using analysis of covariance , the experimental group subjects scored significantly higher on the knowledge post-test when compared to scores of control group subjects ( P = 0.0045 ) . Analysis of variance for repeated measures revealed no significant difference in performance of tasks for the control group and experimental group ( P = 0.08 ) . In a follow-up study , the effect of the self-instructional program ,  practice time , and contracting were explored for their effect on adherence to self-care activities . Experimental groups ( n = 42 ) scored significantly better than the control group ( n = 11 ) on the knowledge post-test ( P < 0.01 ) , performance of joint protection practice s ( P = 0.01 ) , range of motion exercises ( P = 0.01 ) , and adherence to joint protection practice s at home ( P < 0.01 ) . Groups did not differ on adherence to range of motion exercises at home ( P = 0.83 ) The shift in patterns of disease toward chronic illness necessitates greater patient participation in its management and in their own rehabilitation , and they require greater social support over longer peiods . Patient activation , or the enhancement of patient and support group involvement in personal health care through teaching management techniques and problem-solving skills , has emerged in health education in response to this need . This paper will examine combined educational and behavioral approaches to increasing social support and patient activation  in hypertension management . Activation in this study involves increased feelings of personal control over the contingencies surrounding the management of medical regimens . Both family support intervention and small group sessions oriented to changing compliance behavior by changing expectancy frames were offered to a r and omized sample of 200 inner city , black , hypertensive patients who were part of a larger study . Patients were examined within a pretest — posttest r and omized factorial design on measures of locus of control , belief in seriousness , efficacy of treatment , medication compliance , and blood pressure control . This combined approach showed small differences on the attitude and behavioral measures but displayed a significant effect on the program outcome variableblood pressure control ( 62 % in control among intervention groups versus 46 % in nonintervention groups ) A structured treatment and teaching programme for non-insulin-treated non-insulin-dependent ( type 2 ) diabetes was evaluated prospect ively in general practice . The four group sessions were mainly conducted by paramedical personnel . 65 patients from five general practice s were assessed at the start of the programme and 50 ( mean age 65 years , diabetes duration 7 years ) completed the 1 year follow-up ( intervention group ) . The control group consisted of 49 patients ( mean age 63 years , diabetes duration 7 years ) from three other general practice s without the programme . In the intervention group the percentage of patients receiving sulfonylureas  fell from 68 % at the start of the study to 38 % after 1 year ( mean difference 30 % , 95 % confidence interval [ CI ] 16 - 44 % ) ; the mean weight loss was 2.7 kg ( 95 % CI 1.6 - 3.8 kg ) , and non-fasting triglycerides were reduced by 0.77 mmol/1 ( 95 % CI 0.35 - 1.19 mmol/l ) ; and glycosylated haemoglobin remained unchanged ( 7.1 % of total haemoglobin ) . In the control group none of these indices was changed during the study year , and 10 % of patients started insulin treatment . The structured treatment and teaching programme improved the overall quality of patient care in elderly non-insulin-dependent diabetic patients treated by general practitioners OBJECTIVE To evaluate the effectiveness of a community-based arthritis education program conducted in a number of locations throughout the Sydney , Australia , metropolitan area . METHODS The program , based on earlier work , comprised 6 weekly sessions of 2.5 hours ' duration . The study sample included 175 men and women with different types of arthritis , divided into intervention ( n = 104 ) and control ( n = 71 ) groups . Five outcome measures were selected to evaluate effectiveness of the program : pain perception , knowledge level , self-efficacy , disability index , and self-management behavior . RESULTS The results indicated that the program was effective in increasing knowledge level ( F[1,222 ] = 10.3 , P = 0.001 at 6 weeks ; F[1,108 ] = 7.8 , P = 0.006 at 6 months ) , and a statistically significant difference was found in disability satisfaction 6 months after intervention ( F[1,98 ] = 5.9 , P = 0.01 ] , but no statistically significant difference was found in pain perception , self-efficacy , and disability index . CONCLUSION This research supports some of the successful outcomes which follow an arthritis education program : increased knowledge level and increased disability satisfaction The effectiveness of an educational program to increase compliance with cromolyn sodium was assessed in 31 children and adolescents 6 to 17 years of age . Patients were r and omly assigned to an education or noneducation group . A st and ard education program regarding asthma and asthma medications was provided to the education group during four monthly visits . At each visit , all patients were assessed in terms of knowledge of asthma and medications , asthma-related symptoms , and pulmonary function . Patients were also asked to self-rate their compliance . The education program increased the patients ' knowledge of cromolyn , and appeared to result in increased cromolyn compliance . Post-hoc analyses , however , suggested that increased compliance did not correspond to improved medical status unless the quality of management ( by physician and parents ) of the child 's asthma was taken into account . These results suggest that inadequate management of asthma in children may be a more serious problem than patient noncompliance Study objective : To determine whether a self-management training program decreases emergency department visits and reduces costs for patients with asthma . Design : R and omized controlled trial of an educational program . Setting : Two sites — an urban emergency room and a suburban emergency room . Patients : 241 asthma patients between the ages of 18 and 70 years . Of the 119 patients in the intervention group and the 122 in the control group , 185 ( 76 % ) were available for follow-up . Intervention : All patients seen in the emergency departments were given usual medical care and follow-up . Patients in the intervention group were asked to attend three educational sessions on asthma conducted by a specially trained RN . The program stressed importance of medication compliance , methods to control and prevent attacks , effects of drugs and rationale for their use , relaxation exercises , and smoking cessation . Measurement and main results : All patients received telephone interviews four , eight , and 12 months after entry into the study . Reports based on hospital admissions and emergency room utilization were verified by billing records . Three patients died during the study , none from asthma-related problems . The intervention group had significantly fewer asthma-related emergency visits ( 16 visits per 100 persons ) than did the control group ( 39 per 100 persons ) ; p=0.0005 for the 12 months of follow-up . The effect of the intervention on asthma-related emergency department visits was strongest during the initial four months postintervention ( 68 per 100 persons versus 220 per 100 persons , p=0.003 ) . The financial analysis showed that the $ 85/person cost for the educational sessions was offset by the $ 628/person reduction in emergency room charges . Conclusion : Education enables patients with asthma to decrease utilization of emergency services OBJECTIVE To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients . DESIGN A partially r and omized controlled trial involving two groups of patients : Group A , subjects who received an education program followed by 18 months of support group sessions ; Group B , only the diabetes education program . A third convenience sample , Group C , received neither intervention . Groups A and B were assessed before and immediately after the education program , and all groups were assessed 2 years after the education program . SETTING Diabetes clinic at a Veterans Affairs Medical Center . PATIENTS All subjects were male ( mean age = 68 + /- 1.3 years , range = 57 - 82 years ; duration of diabetes = 10 + /- 2 years , range 3 - 16 ) . Sample sizes were 11 in Group A , 13 in Group B , and 8 in Group C. INTERVENTION The education program consisted of six weekly sessions covering aspects of diabetes self-care . The support group consisted of 18 monthly sessions for continuing education , discussion , and structured social activities . OUTCOME MEASURES Diabetes knowledge , psychosocial factors ( self-care-related quality of life , stress , family involvement in care , and social involvement ) , depression , and glycemic control . RESULTS Group A scored better ( at least P less than 0.05 ) on knowledge , quality of life , and depression than the other groups . Groups A and B showed less stress , greater family involvement , better glycemic control , but less involvement in social activities than Group C. CONCLUSION Diabetes education programs can have long term benefits on knowledge , psychosocial functioning , and glycemic control for older diabetic patients . The addition of support groups enhances diabetes knowledge and psychosocial functioning OBJECTIVE Self-management courses in arthritis have been shown to improve outcomes and to decrease medical re source utilization . We studied the effectiveness of a mail-delivered arthritis self-management program with the potential for extending these effects more broadly . METHODS R and omized controlled trial of 375 program participants and 434 controls over a 6 month period . Baseline and 6 month data were analyzed for each group and between groups by paired 2 sample t test . The intervention consists of health assessment question naires at 3 month intervals , with computer processed recommendation letters and reports individualized to age , diagnosis , education level , disability , pain , medication , and other patient-specific variables . RESULTS At 6 months , outcomes of function ( 4.7 % ; 95 % confidence limits 2.7 , 6.7 ) , decreased pain ( 9 % ; 2.8 , 15.2 ) , global vitality ( 7 % ; 2.8 , 11.2 ) , and joint count ( 28 % ; 20 , 36 ) were improved in the program group compared with controls ( p < 0.01 ) . Exercise ( 35 % ; 26 , 44 ) and self-efficacy ( 14.7 % ; 9 , 20 ) were increased in the program group but not controls ( p < 0.001 ) . Doctor visits/year were decreased by 16 % ( 3 , 29 ) in the program group compared with controls ( p < 0.05 ) and days missed work or confined to home decreased by 52 % ( -3 , 107 ) in the program group compared with controls ( p = 0.06 ) . At one year , patients in the original program group continued to improve , and the control group , provided with the program in the second 6 months , showed improvement similar to the first 6 months of the original program group . CONCLUSION A mail-delivered arthritis self-management program can positively affect patient outcomes and can decrease medical re source utilization BACKGROUND --Previous work has indicated a high rate of non-attendance at hospital based clinics among young , multiracial asthmatic patients of lower socioeconomic class . The efficacy of delivering asthma education from a community health centre established in a multiracial working class neighbourhood was evaluated . METHODS --A prospect i ve controlled study was performed in which asthmatic subjects aged between two and 55 years attending a hospital emergency room with acute asthma and living within a defined geographical area of high emergency room users were r and omised to the usual follow up or the education centre plus usual follow up . Measurements were taken at entry into the study and again nine months later . RESULTS --At nine months patients r and omised to the education centre had more preventive medications , more peak expiratory flow meters and better flow meter technique , more self-management plans , better knowledge of appropriate action to take when confronted with worsening asthma , less nocturnal awakening , and better self-reported asthma control than the control group . There was no difference between the study groups in measurements of compliance , hospital admission , days lost from school or work , or emergency room use . CONCLUSIONS --The main effects of education were on asthma knowledge and self-management skills , whilst improvements in asthma morbidity were small . Potential reasons for this include heterogeneous study population ( in terms of baseline self-management skills , asthma severity , ethnicity and age ) , pragmatic study design , insensitivity of many of the measurements of morbidity , the modest effectiveness of a single time limited education programme , and inability to limit the effects of such a large community based study to the intervention group ( there was a 67 % reduction in asthma admissions during the study period from the geographical area targeted compared with a 22 % reduction for the rest of Auckl and ) The efficacy of an adult asthma self-management program , Wheezers Anonymous ( WA ) , was tested utilizing 79 adult asthmatic patients . Subjects were r and omly assigned to a treatment or waiting-list control group . Baseline data gathered included measures of symptom severity , health-care utilization , knowledge of asthma , attitudes about asthma , and self-efficacy . All subjects completed the same measures 1 , 2 , and 3 months following the WA intervention . Knowledge about asthma increased in the treatment group relative to the waiting-list controls ; the number of attacks decreased in the treatment group only , thus demonstrating the efficacy of the WA program OBJECTIVE To evaluate a concise program of self-care education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis ( OA ) . METHODS An attention-controlled clinical trial ; 211 inner-city patients with knee OA were assigned arbitrarily to education ( E ) or attention-control ( AC ) conditions . Group E received an individualized 30 - 60-minute educational intervention that emphasized nonpharmacologic management of joint pain , preservation of function by problem-solving , and practice of principles of joint protection . Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new self-care activities . Group AC viewed a 20-minute st and ardized public education presentation on arthritis and received followup telephone calls ( only to encourage continued participation in the study ) . Outcomes included the Health Assessment Question naire ( HAQ ) Disability and Discomfort Scales , 10-cm visual analog scales measuring knee pain at rest and while walking , and the Quality of Well-Being ( QWB ) scale . Assessment s were made at baseline and at 4-month intervals for 1 year . RESULTS A total of 165 subjects ( 78 % ) completed all assessment s. After control for baseline status , group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup ( P < 0.05 for both ) . Effects were somewhat discordant . By 12 months , functional benefits had begun to wane , while the effect on resting knee pain had grown . The overall effects of education on walking knee pain , overall joint pain ( by HAQ ) , and general health status ( by QWB ) were not significant . CONCLUSION Self-care education for inner-city patients with knee OA , delivered as an adjunct to primary care , was found to result in notable preservation of function and control of resting knee pain . The magnitude of the observed effects compares well with those of more labor-intensive and time-consuming intervention models . However , more sustained preservation of function and consistent effects on pain may require prolonged , more proactive followup , either by the patient educator or by a trained clinical assistant dedicated to the task of supporting self-care by patients with knee OA OBJECTIVE This r and omized controlled clinical trial evaluates the effectiveness of outpatient group cognitive/educational treatment for patients with the fibromyalgia ( FM ) syndrome . We hypothesized that the combination of group education with cognitive treatment aim ed at developing pain coping skills would be more effective than group education alone . METHODS 131 patients with FM were r and omly assigned to 3 conditions : an experimental condition , which was the combined cognitive/educational intervention ( ECO ) ; an attention control condition consisting of group education plus group discussion ( EDI ) ; and a waiting list control ( WLC ) . For the treatment conditions ECO and EDI , assessment s were made 2 weeks before treatment , at start of treatment , at post-treatment , and at 6 and 12 mo followup . WLC patients received only 3 assessment s. RESULTS There were no pretreatment differences between the groups , or between dropouts and patients who remained in the study . At post-treatment , and compared with the WLC , the ECO patients improved in knowledge about FM ( p = 0.007 ) and pain coping ( p < 0.001 ) . EDI patients improved on pain coping ( p = 0.005 ) and pain control ( p = 0.002 ) . EDI patients reported significantly less fear than ECO patients ( p = 0.005 ) . There were no other differential effects between ECO and EDI at post-treatment or 6 mo or 12 mo followup . Based on the reliability of change index for clinical significance , the relative short term success rates are 6.4 and 18.4 % for ECO and EDI , respectively . CONCLUSION The surplus value of a highly structured , 12 session group cognitive treatment added to group education can not be supported by our study . In EDI , fear reduction might have enhanced pain coping and pain control , while poor compliance , the difficulty of homework assignments , and lack of individual support may have limited the effectiveness of ECO Three health education interventions for urban poor hypertensive patients were introduced sequentially in a r and omized factorial design : 1 ) an exit interview to increase underst and ing of and compliance with the prescribed regimen ; 2 ) a home visit to encourage a family member to provide support for the patient 's regimen ; and 3 ) invitations to small group sessions to increase the patient 's confidence and ability to manage his/her problem . Previous evaluation of the initial two-year experience demonstrated a positive effect of the educational program on compliance with the medical treatment and blood pressure control . Data accumulated over an additional three years , including mortality analysis , are now presented . The study group consisted of the same cohort of 400 ambulatory hypertensive out patients in the eight experimental and control groups . The five-year analysis shows a continuing positive effect on appointment keeping , weight control , and blood pressure control . All-cause life table mortality rate was 57.3 per cent less for the experimental group compared to the control group ( 12.9/100 vs 30.2/100 , p less than .05 ) , while the hypertension-related mortality rate was 53.2 per cent less ( 8.9/100 vs 19.0/100 , p less than .01 ) . The results from this longitudinal study provide evidence to encourage health practitioners to utilize such educational programs in the long-term management and control of high blood pressure An important unanswered question about rheumatoid arthritis ( RA ) is how the patient 's psychological or emotional state relates to disease activity and functional status . No controlled studies of psychotherapeutic interventions in RA have been reported . To test the hypothesis that a psychosocial intervention would lead to improvement in functional status or disease activity , 57 RA patients were r and omly assigned to 1 of 3 groups , which received : 1 ) conventional group psychotherapy ; 2 ) group assertion/relaxation training ; or 3 ) no treatment ( control group ) . Patient and physician question naires collected at baseline , immediately after the interventions , and 12 months after baseline provided outcome data on functional status , social and psychological adaptation , psychological symptoms , and disease activity . There were few outcome measures for which either treatment result ed in significantly higher scores than were seen in controls , though more improvement did occur among patients who received conventional group psychotherapy OBJECTIVES Re- analysis of a r and omized trial of an asthma education program design ed to assess the effects of the intervention on emergency department visits , limited days of activity and asthma knowledge and beliefs separately for African American and Caucasian adults with asthma . DESIGN Two hundred and forty-one respondents between the ages of 18 and 70 were evaluated in two emergency departments ( one inner city and one suburban location ) of a large , midwestern health care system and were r and omized to an intervention or control group . RESULTS Regardless of race , members of the intervention group showed a decrease in the number of post-intervention emergency department visits ( ANOVA interaction between race and group effect p value = 0.93 ) . The greatest decrease occurred during the first four post-intervention months . No differential effect of the asthma education intervention by race was found on the change in asthma knowledge and beliefs over the study period ( ANCOVA interaction between race and group effect p value = 0.60 ) . CONCLUSION This study demonstrates that post-intervention , both African American and Caucasian study participants showed a decrease in emergency department visits and an increase in asthma self-management . This finding is especially important for African Americans , who face increasing asthma mortality and morbidity OBJECTIVE Evaluation of a structured hypertension treatment and teaching programme in general practice . DESIGN Prospect i ve controlled trial ; follow-up period 18 months . SETTING 10 primary health care practice s. PRACTICE S AND PATIENTS : From each practice 20 patients ( 30 to 60 years old , mean of the last two blood pressure measurements at or above 160 and /or 95 mmHg ) were r and omly selected ; in 5 practice s these patients were to participate in the treatment and teaching programme ; in the remaining 5 practice s hypertension care was continued without the availability of such a programme ( controls ) . INTERVENTION Structured treatment and teaching programme based upon four group sessions for patients mainly conducted by paramedical personnel . MAIN OUTCOME MEASURES Blood pressure , body weight , prescription of antihypertensive drugs - as documented in the patient 's records . MAIN RESULTS Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation ; 46 patients had agreed to participate in the programme . The mean number of prescribed antihypertensive agents per patient decreased in the intervention group ( 1.8 + /- 1.3 at baseline , vs 1.2 + /- 1.2 at follow-up ) compared to the control group ( 1.6 + /- 1.3 vs 1.8 + /- 1.6 ) ; difference 0.8 ( 95 % CI 0.4 to 1.1 ) , p < 0.0001 . In the control group 9 % and in the intervention group 33 % of patients had documented reductions of body weight ( p < 0.0001 ) . Blood pressure decreased in the intervention group ( 162 + /- 14/100 + /- 7 mmHg at baseline , vs 154 + /- 16/95 + /- 9 mmHg at follow-up ) compared to the control group ( 161 + /- 13/98 + /- 7 mmHg vs 158 + /- 18/96 + /- 11 mmHg ) ; differences for systolic blood pressure 5 ( 95 % CI 0 to 10 ) mmHg , p = 0.071 ; for diastolic blood pressure 4 ( 1 to 7 ) mmHg , p = 0.018 . CONCLUSIONS The introduction of a structured hypertension treatment and teaching programme in general practice may lead to significant improvements of hypertension care OBJECTIVE To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia ( FMS ) symptoms and increasing physical and psychological well being . METHODS A pretest-posttest control group design was used . Ninety-nine women with FMS were r and omly assigned to 1 of 3 groups ; 86 completed the study . The education only group received a 6-week self-management course . The education plus physical training group received the course and 6 h of training design ed to assist them to exercise independently . The control group got treatment after 3 months . RESULTS The experimental programs had a significant positive impact on quality of life and self-efficacy . Helplessness , number of days feeling bad , physical dysfunction , and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program . Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Question naire primarily in the physical training group . Among all subjects , 87 % were exercising at least 3 times/week for 20 min or more ; 46 % said they had increased their exercise level since participating in the program ; 70 % were practicing relaxation strategies as needed ; 46 % were working at least half time as opposed to 37 % at pretest . CONCLUSION Self-efficacy of the treated groups was enhanced significantly by the program . Other changes were smaller and more delayed than had been expected . Recommendations for future trials include a longer education program , more vigorous physical training , and longterm followup Home health nurses provided individualized instruction in diabetes self-care within the home environment of 393 diabetic individuals . Each subject was r and omly assigned to either the intervention ( those receiving home teaching ) or control ( those not receiving home teaching ) group . At 6 mo postenrollment , intervention subjects showed significantly greater self-care knowledge and skills than control subjects , although the actual differences between the two groups in terms of self-care skills were probably too small to have any practical meaning . The primary objective of the study , which was the reduction of the number of preventable diabetes-related hospitalizations ( ketoacidosis , ketotic coma , nonketotic coma , insulin reaction , and diabetes out of control ) , was not achieved ; no differences between the groups were noted after 12 mo of follow-up . Similarly , length of hospital stay , foot problems , emergency room and physician visits , and sick days were roughly equivalent in both groups during the follow-up year . These results suggest that , in the absence of concurrent changes in the health-care delivery system and strategies for influencing attitudes toward self-care , education alone is ineffective & NA ; The effectiveness of a Pain Education Program in cancer patients with chronic pain offered by nurses was investigated in a r and omized controlled clinical trial . A multi‐ method approach was used in which verbal instruction , written material , an audio cassette tape , and the use of a pain diary were combined to inform and instruct patients about pain and pain management . The Pain Education Program was tailored to the needs of the individual patient and consisted of three elements : ( 1 ) educating patients about the basic principles regarding pain and pain management ; ( 2 ) instructing patients how to report their pain in a pain diary ; and ( 3 ) instructing patients how to communicate about pain and how to contact health care providers . Following pretesting in 313 patients , patients who needed district nursing and who did not need district nursing at home were r and omly assigned to a control or intervention group . Intervention group patients received the Pain Education Program in the hospital , and 3 and 7 days postdischarge by telephone ; this was done by nurses who were specially trained as pain counselors . Follow‐up assessment s were at 2 , 4 and 8 weeks postdischarge . Results of the pretest showed that many patients lacked knowledge about pain and pain management . The majority of pain topics had to be discussed . The Pain Education Program proved to be feasible : 75.0 % of the patients had read the entire pain brochure , 55.7 % had listened to the audio cassette , and 85.6 % of pain scores were completed in the pain diary . Results showed a significant increase in pain knowledge in patients who received the Pain Education Program and a significant decrease in pain intensity . However , pain relief was mainly found in the intervention group patients without district nursing . It can be concluded that the tailored Pain Education Program is effective for cancer patients in chronic pain . The use of the Pain Education Program by nurses should be seriously considered on oncology units The prevalence and impact of adult asthma are substantial , and poor self-management practice s , especially failures to adhere to treatment regimens , appear to be a significant problem . Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education re sources . A comprehensive program was developed that integrated a workbook with one-to-one counseling and adherence-enhancing strategies . A longitudinal 1-year study compared patients receiving this self-management program with " usual care " patients receiving st and ard asthma pamphlets . Patients were r and omly assigned to conditions . Baseline score and asthma severity were statistically controlled . Self-management patients had substantially better adherence than usual care patients , as well as improved functional status , at follow-up . Hospital and emergency department visits decreased in both groups but did not differ between groups PURPOSE Excess morbidity and mortality due to asthma , aggravated by demonstrably poor patient self-management practice s , suggest the need for formal patient education programs . Individual and group asthma education programs were developed and evaluated to determine their cognitive , behavioral , and clinical effects . PATIENTS AND METHODS We compared changes in asthma symptoms , utilization of medical services , knowledge about asthma , metered-dose inhaler ( MDI ) technique , and self-management behaviors for 323 adult Kaiser Permanente patients with moderate to severe asthma who were r and omly assigned to  small-group education , individual teaching , or 1 of 2 control conditions -- an information ( workbook ) control or usual control ( no formal asthma education ) . Data were collected from patients by question naire , diary , and physical examination at enrollment and at 5 months and 1 year after intervention . Medical record data on these patients were abstract ed for a total 3-year period , from 1 year before to 2 years after enrollment . RESULTS Compared with the usual control , the self-management education programs were associated with significant improvements in control of asthma symptoms ( reduced " bother " due to asthma and increased symptom-free days ) , MDI technique , and environmental control practice s. Small-group education also was associated with significant improvements in physician evaluation of the patients ' asthma status and in patients ' level of physical activity . For both group and individual education recipients , improvement in MDI technique was positively correlated with improved control of symptoms ; however , the degree of improvement in symptoms was greater than that which could be accounted for on the basis of improvement in MDI technique alone . The time course over which changes occurred in the various outcome measures suggests the mechanism by which education result ed in improvement in the patient 's status . Significant improvements in MDI technique and environmental control practice s were manifest immediately following education ( 5-month follow-up ) and at the 1-year follow-up . Significant improvements in symptom measures were not apparent until the 1-year follow-up . The rate of utilization of medical care for acute exacerbations decreased between baseline and the 2-year follow-up period , but this decrease did not differ significantly among treatment conditions . However , there was a trend toward greater reduction in patients receiving small-group education . An ad hoc finding of a significant difference favoring small-group education between the baseline and the second follow-up year acute visit rates was observed . This result must be regarded as tentative , since it is not clear that unambiguous statistical significance is attained in the light of multiplicity issues . However , this trend is consistent with the antecedent benefits of the small-group education , and appears to warrant further investigation . CONCLUSIONS Carefully design ed asthma education programs for adults can improve patients ' underst and ing of their condition and its treatment and increase their motivation and confidence that the condition can be controlled , thereby increasing their adherence to the treatment regimen and management of symptoms , and , in turn , improving control of symptoms . Both small-group education and individual education were associated with significant benefits , but the group program was simpler to administer , better received by patients and educators , and more cost-effective . The results show promise for improving clinical outcomes , through well- design ed educational programs , for patients with asthma and other chronic health problems Despite the wide availability of disease-related leaflets , their impact on patients ' knowledge and well-being has rarely been evaluated . A r and omized controlled study of a ' Rheumatoid Arthritis ' leaflet revealed increased knowledge among the intervention group after 3 weeks . In addition , the leaflet was viewed as a source of reassurance . The purpose of the follow-up study was to determine whether the increase in knowledge was maintained in the longer term and to examine psychological well-being .  Eighty-four patients ( 42 intervention and 42 control ) completed the 6 month follow-up . There were no significant changes ( P > 0.01 ) in mean outcome measures over the period 3 weeks-6 months for either the intervention or control groups . Patients in the intervention group retained the increase in knowledge observed at 3 weeks . Moreover , there was no evidence of adverse reactions to the leaflet in terms of psychological distress .  Leaflets can be effective in promoting longer term increases in knowledge PURPOSE Patients who have undergone coronary artery bypass graft surgery ( CABG ) are obvious c and i date s for rehabilitation programs because of the potential for progression of disease . Such programs have been shown to foster risk-factor modification , improve quality of life , and prolong survival among post-myocardial infa rct ion ( MI ) patients . However , the efficacy of these programs has not been established among patients who have undergone CABG . METHODS A r and omized controlled trial was employed to evaluate whether a behavioral and educational cardiac rehabilitation program was effective in modifying cardiovascular disease risk factors and improving quality of life in a cohort of 86 patients after CABG . Patients were recruited from the cardiac ward of a large teaching hospital and were block-r and omized to either an intervention group or routine care . Subjects in the intervention group attended 6 weekly group sessions following hospital discharge , and booster sessions at 8 months and 1 year . They also received a personalized behavior modification program based on their baseline risk factors . Risk factor and quality of life measures were recorded at baseline ( 6 weeks after surgery ) , 4 months , 8 months , and 1 year . RESULTS The results indicated few differences between the study groups . However , the intervention group 's aerobic capacity ( VO2max ) improved over that of the routine care group . With regard to the quality of life variables , all patients tended to improve steadily over time . CONCLUSIONS The relatively moderate success of this intervention program compared with various post-MI studies may be indicative of differences between the treatment needs of patients after acute myocardial infa rct ion or CABG . Future post-CABG rehabilitation research should explore these patients ' unique treatment needs , and investigate a variety of program strategies The effects of an educational program on compliance and blood pressure ( BP ) control were assessed in 47 hypertensive patients hospitalized for nonhypertension-related diseases . Patients were r and omized to receive either a question naire and an educational program ( group I , 25 ) or question naire only ( group II , 22 ) . Baseline clinical characteristics , admission diagnoses and antihypertensive medications were similar between the groups . Antihypertensive medications used by patients before the trial were not changed . Eight weeks after the initial intervention , patients in group I showed a significant reduction in both systolic and diastolic BP ( 137/89 vs 154/98 mm Hg , p = 0.005 and 0.006 , respectively ) and improved compliance ( 96 vs 36 % , p = 0.04 ) , compared with patients in group II . An education program in patients with high BP is an effective method to improve compliance and BP control in the short-term To examine the effects of intensive patient and /or physician diabetes education on patient health outcomes , a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were r and omly assigned to : routine care ; patient education ; physician education ; or both patient and physician education . Patient outcome data were analyzed either by analysis of covariance on post intervention values ( 2-hour post-pr and ial plasma glucose [ PPG ] ; body weight [ BW ] ; blood pressure [ BP ] ; or analysis of variance conducted on change values ( fasting plasma glucose [ FPG ] and glycosylated hemoglobin [ A1Hgb ] ) . After patient education , significant improvements were observed in FPG , A1Hgb , BW , and systolic and diastolic BP . Physician education result ed in significant decreases in FPG , A1Hgb and BW . The combination of patient plus physician education result ed in the greatest improvements in patients ' health outcomes including FPG , A1Hgb , PPG , BW and diastolic BP . Adjusted systolic BPs were not significantly different in the two groups . While these physiologic improvements were statistically and probably clinical ly significant , hyperglycemia and obesity still persisted . Thus , achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of re sources than currently estimated A sample of 310 low income urban children with asthma from 290 families was r and omized into a control group and an experimental group that received health education to improve asthma management at home . No significant decreases in subsequent health care use were observed when the experimental group was compared to the control group without regard to previous hospitalization . When the comparison was restricted to children who had been hospitalized during the preceding year , however , the experimental group was found to have decreased its use of the emergency room significantly more than the control group ( p less than 0.05 ) and to have experienced a significantly greater reduction in the mean number of hospitalizations ( p less than 0.05 ) during the year of follow-up . The program reduced health care costs for children with one or more hospitalizations , saving $ 11.22 for every $ 1.00 spent to deliver health education This study was planned in the context of a regional high blood pressure programme , to compare the efficacy of two educative methods . The group of 722 hypertensive patients ( 58.8 % women ) , mean age 61 years , was r and omly selected from 19 primary care centres . Initial assessment was based on a patient interview including 22 questions on high blood pressure , its consequences and treatment . Patients agreeing to participate in an active education team programme were distributed into three groups : individual education , team education and a control group . Those who declined to participate formed two groups : individual education and controls . Team education consisted of two audiovisual sessions attended by groups of 8 - 12 patients and conducted by treating physicians and nurses . Individual education included comments related to the 22 questions . Follow-up assessment was made after two months . An increase in the level of hypertension control was observed only in the accepting group , in which educative action was followed by increased knowledge . Results were similarly favourable for both the individual and team education groups and suggested the need to consider educational factors together with those influencing patient attitude towards an active educational programme OBJECTIVE To evaluate the effects of a program for individual education in combination with the use of an arthritis passport . METHODS We studied 3 groups of patients with rheumatoid arthritis . The first experimental group received educational material s and followed the program under the guidance of their regular providers of health care whose activities were coordinated through arthritis passports . The second experimental group only received education material s ; the  control group received only usual care . RESULTS There were no effects on self-efficacy expectations , knowledge , health status , or behavior in either experimental group . Opinions of general practitioners , physiotherapists , and visiting nurses concerning the arthritis passport were very positive , but rheumatologists ' opinions were not . Opinions on coordination of care were more positive among the physiotherapists of the experimental group . CONCLUSIONS Individual education for patients with rheumatoid arthritis by health care providers during routine consultations , as implemented in this program , had no effect on self-efficacy expectations , knowledge , health status , or health behavior . Likewise , the distribution of educational material s by itself without the involvement of health care providers had no effect . The use of the arthritis passport improved coordination of care , especially for physiotherapists BACKGROUND The management of oral anticoagulation is fraught with difficulties . This study assessed a new model of anticoagulation management regarding the ability , safety , and efficacy of patients to self-monitor and self-adjust the dose of their oral anticoagulants guided by a capillary whole-blood prothrombin time ( PT ) monitor . METHODS This investigation is a retrospective cohort study of 20 patients compared with 20 matched control patients receiving oral anticoagulation at a tertiary medical institution . RESULTS Study patients monitored their PTs 2153 times during a mean interval of 44.7 months compared with 1608 PTs in matched control patients during a mean interval of 42.5 months . Study patients made an average of 11.5 dosage changes per patient , contrasted with 22.7 changes per control patient ( P < .001 ) . The PTs in study patients were within the recommended therapeutic range in 88.6 % ( 95 % confidence interval , 87.2 to 89.9 ) of the determinations compared with 68.0 % ( 95 % confidence interval , 65.7 to 70.3 ; P < .001 ) of the determinations made by the matched control patients . In response to the 2153 PTs , study patients made 67 ( 3.1 % ) dosage decisions that were considered incorrect based on physician guidelines . None of these changes led to adverse outcomes . There was no significant difference in complication rates between the two groups . CONCLUSIONS Results from what is the first long-term study of patient self-monitoring of PTs and self-adjustment of the warfarin sodium dosage for oral anticoagulation suggest that patients can successfully measure their own PTs , adjust their own warfarin dosage , and achieve a degree of therapeutic effectiveness at least as good , if not better than patients managed in an anti-coagulation clinic . Larger , prospect i ve , r and omized trials are needed to confirm the efficacy and safety of this new approach to therapy and to assess its cost-effectiveness A 5-yr follow-up of an arthritis education programme is reported . After adjustment for those lost , deceased or moved away , the 5-yr response rate was 75 % among intervention subjects and 78 % among controls . Individuals who participated in the education programme maintained their increased knowledge in some aspects . The relative difference in pain and disability over 5 yr was greater in the control group . Most individuals were less active at practising exercise after 5 yr . Improvement in performing exercise and joint protection shown at 12-months follow-up did not persist . Additional questions after 5 yr showed that participants in the education programme had significantly more contact with rheumatologists , physiotherapists and occupational therapists . The participants developed an increased internal sense of control of the disease between 12 months and 5 yr . There was also a significant reduction in reported problems with their disease after 12 months , maintained after 5 yr . This may indicate that patient education contributes to the patient 's feeling of responsibility for , and ability to cope with , their diseases Abstract Objective : To compare the efficacy of self management of asthma with traditional treatment . Design : 12 month prospect i ve r and omised trial . Setting : Outpatient clinics in Finl and . Subjects : 115 patients with mild to moderately severe asthma . Interventions : Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements . Main outcome measures : Unscheduled admissions to hospital and outpatient visits , days off work , courses of antibiotics and prednisolone , lung function , and quality of life . Results : The mean number of unscheduled visits to ambulatory care facilities ( 0.5 v 1.0 ) , days off work ( 2.8 v 4.8 ) , and courses of antibiotics  ( 0.4 v 0.9 ) and prednisolone ( 0.4 v 1.0 ) per patient were lower and the quality of life score ( 16.6 v 8.4 at 12 months ) higher in the self management group than in the traditionally treated group . In both groups admissions for asthma were rare . Conclusions : Self management reduces incidents caused by asthma and improves quality of life . Key messages Key messages This trial of 115 patients with mild to moderately severe disease r and omised half to a traditional care and half to a self management programme consisting of education about asthma and daily peak flow readings Intervention thresholds of < 85 % of the optimal peak flow for doubling the dose of inhaled steroid for two weeks and of < 70 % of the optimal peak flow for starting a course of oral steroids worked well The self management group had fewer incidents ( consultations , days off work , courses of prednisolone or antibiotics ) than the traditionally treated group and better quality of life scores Adherence of patients to the self management instructions was better than Arthritis is a common chronic disease causing pain and progressive disability to millions of people . The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis , ankylosing spondylitis ( AS ) , in terms of change in : arthritis self-efficacy ; psychological well-being ; physical well-being ; and home exercise activities . The Self-Management Course-Ankylosing Spondylitis ( SMC-AS ) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up . Analysis of change over time in the intervention group showed improvements in depression , self-efficacy and severity at 3 weeks , with trends towards continued improvement evident at 6 months . In contrast , the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months . In conclusion , the effectiveness of short , intensive patient education courses was demonstrated . However , the need for strategies to sustain improvements in exercise behaviour need to be explored We assessed diabetes education and peer support interventions as facilitators of weight loss and glycemic control in a community sample of 79 elderly persons with noninsulin-dependent diabetes mellitus ( NIDDM ) . Different groups received : education only , education and peer support , and no treatment .  Peer support was higher in groups where it was actively facilitated . Weight loss and reduction in level of glycemic control occurred within groups receiving both diabetes education and peer support Forty three patients with essential hypertension participated in a study on the effectiveness of stress-management training for essential hypertension . After 6–9 clinic and 48 self-measured readings of systolic and diastolic blood pressures ( SBP and DBP ) , 22 patients were treated with a program  based on education , relaxation , and problem-solving training ; and another 21 patients were assigned to a waiting list control group . At post-treatment , mean reductions of clinic BP ( 17/13 mm Hg vs. 6.9/4.7 mm Hg for SBP/DBP ) , percentages of subjects who achieved at least a 5 mm Hg reduction ( 86/86 % vs. 48/48 % for SBP/DBP ) and percentages of subjects who in addition achieved a normotensive level ( 59/68 % vs. 29/14 % for SBP/DBP ) were significantly higher in the treated group than in the control group . Concerning self-measured BP , the effectiveness of the stress-management training  was not so considerable ( mean reductions of 3.6/2.4 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 52/38 % for SBP/DBP ) , but it was significant and maintained in a 4-month follow-up assessment ( mean reductions of 4/2 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 48/33 % for SBP/DBP ) . It is suggested that stress-management training can be beneficial for treatment of essential hypertension Stress management and mutual support groups are employed widely in chronic illness , although their efficacy has not been established . To determine the effect of these measures on morbidity and psychologic health in rheumatoid arthritis , 105 patients meeting diagnostic criteria for rheumatoid arthritis were evaluated for depression , life satisfaction , functional disability , and indicators of disease activity . Patients were r and omly assigned to one of three groups : ( 1 ) stress management ; ( 2 ) mutual support ; ( 3 ) no intervention ( control ) . After completion of 10 weekly sessions , identical tests were performed for all patients in the intervention and control groups . Patients in the intervention groups showed greater improvement in joint tenderness than did the control patients but did not differ significantly from the patients in the control group in any of the other outcome measures The benefits of patient education for those with chronic arthritis are well documented . Informed patients should practice self care more often , and may show reduced disability from their disease . An important question relates to maintenance of the knowledge and skills acquired in educational programmes . This prospect i ve study evaluated an education programme for people with rheumatoid arthritis ( RA ) and osteoarthritis ( OA ) . The intervention group participated in a comprehensively planned six session behaviourally based programme . A question naire was given to 100 patients and 95 matched but non-r and om controls before the programme , 1 month later , and at 3 and 12 months . The intervention group demonstrated improvements in knowledge , self-reported health behaviour and disability scores at 12 months , compared to the controls . No differences were reported in symptoms , compliance with therapy , pain perception , and locus of control A population -based study on the therapeutic effects of a diabetes teaching programme ( DTP ) based on problem oriented participatory education (POPE)--a method based on learner activity in group meetings -- was undertaken at the Primary Health Care Centre , Kisa , Sweden , in collaboration with educationalists . A control group was given conventional classroom teaching . To be included a patient had to be aged 55 - 73 years , to live in his own home , and to have non-insulin-treated type II diabetes mellitus . The therapeutic effects of the DTP were studied before , during , and after POPE with regard to three factors , diabetes related knowledge , behaviour assessed by dietary and exercise habits , and the quality of the anti-diabetic therapy as assessed by metabolic profile including Hb-A1 . Significant improvement in knowledge and transient improvement in Hb-A1 concentration were recorded among patients taking part in a DTP adjusted to their individual problems and needs . When improvement in metabolic control does not last , group meetings should be continued for more than the three months used in the present study . We believe that such improvement is intimately bound up with the psycho-social process that is involved in the group meetings and that helps the patient to cope with the disease in particular and life in general This paper presents findings from the evaluation of a self-management education program based on self-regulation principles . Older men and women ( N = 324 ) were r and omly assigned to program and control groups . Outcomes were measured using the Sickness Impact Profile . Twelve months following baseline data collection , psychosocial functioning of program participants was significantly better than that of controls . Different program effects were noted when results were analyzed by participant gender The Diabetes Education Study ( DIABEDS ) was a r and omized , controlled trial of the effects of patient and physician education . This article describes a systematic education program for diabetes patients and its effects on patient knowledge , skills , self-care behaviors , and relevant physiologic outcomes . The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center . Patients were predominantly elderly , black women with non-insulin-dependent diabetes mellitus of long duration . Patients r and omly assigned to experimental groups ( N = 263 ) were offered up to seven modules of patient education . Each content area module contained didactic instruction ( lecture , discussion , audio-visual presentation ) , skill exercises ( demonstration , practice , feedback ) , and behavioral modification techniques ( goal setting , contracting , regular follow-up ) .  Two hundred seventy-five patients remained in the study throughout baseline , intervention , and postintervention periods ( August 1978 to July 1982 ) . Despite the requirement that patients demonstrate mastery of educational objectives for each module , postintervention assessment 11–14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge . However , statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous . Experimental group patients experienced significantly greater reductions in fasting blood glucose ( −27.5 mg/dl versus −2.8 mg/dl , P < 0.05 ) and glycosylated hemoglobin ( −0.43 % versus + 0.35 % , P < 0.05 ) as compared with control subjects . Patient education also had similar effects on body weight , blood pressure , and serum creatinine . Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization Objective : To determine the prognosis of treated hypertensive type 1 ( insulin-dependent ) diabetic patients with overt nephropathy . Design : A controlled , prospect i ve , parallel , 5-year follow-up trial . Setting : The tertiary care centre of the Heinrich Heine University Hospital in Dusseldorf , Germany . Patients and interventions : A sequential sample of 91 hypertensive patients with overt diabetic nephropathy participated in a diabetes treatment programme . Thereafter 45 patients received intensified antihypertensive therapy including blood pressure self-monitoring and self-adjustment of antihypertensive drug treatment with the goal of permanent normalization of blood pressure values below 140/90 mmHg . The remaining 46 patients were administered routine antihypertensive therapy and formed the control group . At baseline both groups were comparable in age , sex , metabolic control and renal function . The groups differed at baseline in their duration of diabetes and blood pressure values , which were higher in the intensified antihypertensive therapy group . Outcome measures : Total mortality and the need for renal replacement therapy . Main results : Blood pressure control was significantly improved in patients who were subjected to intensified antihypertensive therapy , whereas it deteriorated in the group of patients who received routine antihypertensive therapy . At follow-up , primary end points of the study occurred in five ( 11 % ) patients of the intensified therapy group and in 19 ( 41 % ) patients of the routine therapy group . According to life table analysis , intensified antihypertensive therapy was associated with less frequent primary end points ( P= 0.0058 ) and longer survival ( P=0.01 ) . The differences between the groups remained significant after adjustment for covariates in the proportional hazards model . Conclusion : Participation in a treatment programme aim ed at intensification of antihypertensive therapy is associated with a reduction of mortality in hypertensive type 1 diabetic patients with overt nephropathy Because the elderly are viewed as having more difficulty in complying with therapy , this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population . The program consisted of three sequential interventions introduced in a r and omized factorial design . Depsite the fact that elderly patients had more chronic disease , more complications from hypertension , and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions , they demonstrated significantly higher levels of compliance with drug therapy , significantly higher levels of appointment keeping , and no difference in the proportion having their BP under control at two-year-follow-up . Longitudinal data collected at five-year follow-up indicate no decay effect . These results indicate such programs can be successfully implemented and equally effective for an elderly population After we assessed the functional status of 439 patients with osteoarthritis , we r and omly assigned them to 1 of 3 intervention groups or to a control group . The interventions consisted of providing information , and differed only in the method of delivery : by phone , in person at the clinic , or both . Physical health improved ( P = 0.02 ) , pain was reduced ( P = 0.02 ) , and psychological health improved marginally ( P = 0.10 ) in patients contacted by phone compared with those not contacted by phone . In those contacted only at the clinic , physical health worsened ( P = 0.02 ) , but neither pain ( P = 0.80 ) nor psychological health ( P = 0.90 ) differed from the values in patients not contacted at the clinic . We conclude that telephone contact is a useful intervention that can enhance the functional status of patients with osteoarthritis
BACKGROUND Self-management programs have been widely reported to help patients manage symptoms and contain utilization of health care re sources for several chronic conditions , but to date no systematic review across multiple chronic diseases has been reported .
We evaluated the efficacy of  patient self-management educational programs for chronic diseases and critically review ed their methodology .