Hospital-based Asthma Education: Health Education
Another pediatric program by Clark and coworkers evaluated the impact of health education on frequency and cost of health-care use by low-income children with asthma. This “open airways” program took place in a hospital setting and attempted to use an education program to reduce ED visits and hospitalization. They also determined whether the effect was greater among high baseline health-care users. Two hundred ninety families with 310 children in all were enrolled, 207 in the experimental group and 103 in the control group who continued to receive their usual care. The program, which was conducted in English or Spanish, consisted of six, 1-hour sessions with parents and children receiving five separate and one joint session itat on buy dexone online. Ten to 15 families were included in each group. They were taught to recognize and deal with asthma attacks, how to take their medications, patient-physician communications, improving the home environment, improving school performance, general fitness instruction, and guidelines regarding physical activities. The major outcome measure was health-care utilization 1 year before and 1 year after the program. No difference was noted overall, but health-care utilization was decreased in the subgroup who used the health-care facilities prior to entering the program. In those children who had been hospitalized during the preceding year, there was a significantly greater reduction in ED utilization and hospitalization (p<0.05). Most important was the cost benefit of the education program that showed a savings of $11 for each dollar spent on the program if there were one or more hospitalizations.
In a study by Rubin and associates, a computer game was used to improve knowledge and asthma treatment behaviors in children 7 to 12 years (the younger ones with the assistance of their parents). Twenty-five children played the “asthma command” game for 40 min (experimental group) vs 29 who played routine games for a similar period of time. They were evaluated every 6 weeks for 10 months. There was a significant improvement in their knowledge and asthma treatment behaviors (p<0.001) but surprisingly there was no difference in physician visits, ED visits, or hospitalization. It appeared that at least in this study utilizing a computer game, there was improvement in understanding of asthma and theoretically how to respond during exacerbations that did not seem to translate into an actual improvement in self-care! Perhaps this is telling us that the best kind of education that is likely to translate into improved self-care can be better accomplished when it involves educators and/or care givers in the teaching process than if it is done solely by computer. Alternatively, perhaps better computerized education systems could be designed and validated.