Hospital-based Asthma Education: Medical Records


Hospital-based Asthma Education: Medical RecordsDuring a 3-month follow-up and in comparison to retrospective data, there was an overall threefold reduction in hospital bed utilization and the same was true of the 19 patients who were crossed over (p<0.004). Additional benefits noted included an increase in the use of inhaled steroid from 20 to 80% and a demonstrated ability to adjust inhaled steroids for exacerbations read more Patients in the experimental group were able to initiate prednisone therapy themselves and there was a reduction in oral medication use and in the need for long-term care. The nurse practitioner appeared to be as effective as the physician in the education process and both were accessible by walk in or phone in. In this study, all patients measured peak flow. Hospitalization costs for the control group during an 8-month follow-up period were $4,000 in contrast to only $1,500 for the patients in the program.
Although it was not hospital-based, a controlled trial of a home and ambulatory program for asthmatic children by Hughes and colleagues is of interest because it was a randomized control trial over 2 years in which 93% completed the study. Education was comprehensive and took place at three monthly clinic visits and during home visits by the research nurse. Control subjects received their usual care from their family physician or pediatrician. At the end of a year, there was much less absenteeism (107 vs 16 days [p=0.04]), better “small airway” function, and less hospitalization (3.7 vs 11.2 days [p=0.02]). In the experimental group, 72% of children undertook self-care vs 33% in the control group (p=0.006). The authors noted that 1 year after the intervention was discontinued, a marked “washout” effect was noted indicating the importance of reinforcement education at annual or semiannual intervals.
It appears then that asthma education programs do have the potential for achieving the goals outlined above. Patients well educated to undertake self-care would appear to lead more symptom-free lives and be able to achieve a better functional status as well as being able to reduce the likelihood of ED visits or hospitalization and the related health care costs. There are, however, significant barriers to asthma education, as outlined in a recent editorial by FitzGerald and colleagues (Table 1).

Table 1—Barriers to Asthma Education

Physician Barriers Patient Barriers
• Primary care consultation time limited • Patients diffident about asking questions of physician during office consultation
• Physicians often appeared hurried and eager to proceed to the next patient • Embarrassment or fear to ask questions
• Physicians usually concentrate on acute aspects of asthma rather than the chronic inflammatory nature of the condition with variability • Patients may forget what they were told in the office setting
• Simple explanations in jargon-free English are often lacking • Patient compliance poor (as with all chronic disease)
• Physician education in the past stressed symptom relief (bronchodilatation) not control of asthma long term with anti-inflammatory medication •    Fear of corticosteroids results in suboptimal dosing•    Skill with aerosol delivery
systems may be poor necessitating valved accessory devices or breath-actuated aerosol inhalers