Hospital-based Asthma Education: Problems Relating to Evaluation of Asthma Education Programs
By far the majority of self-care programs have been initiated by pediatricians and are aimed at children and their parents. Most studies have been uncontrolled and few have had morbidity assessments as a major outcome measure. Asthma education programs have taken place in hospital outpatient clinics most commonly while inhospital or ED programs have been rare. They have also occurred commonly in schools and at asthma camps or via community agencies and in physicians’ offices.
As with most fields of medicine, well-controlled studies have been unusual in the past, but in recent years, there has been an increase in the rigor of such studies with a resulting increase in our ability to design teaching programs that are likely to be effective. Canadian health & care mall so In particular, there have been major problems relating to evaluation of these programs due to baseline differences in the treatment and control groups, bias in subject selection, relatively small numbers of subjects, lack of suitable control subjects, and often the unreliability of some of the outcome measures.
Although there are relatively few studies that are actually hospital based in the sense of studies of patients with asthma on hospital wards or in the ED, it is worth trying to improve our understanding of such programs by briefly reviewing such studies as well as studies relating to hospital-based clinics, since many of the methods used there could readily be applied within the hospital itself.
Fireman and colleagues2 studied a relatively small number of patients in the pediatric age group (age 2 to 14 years) in a university hospital outpatient clinic. One of the major limitations of this study was the small number of subjects—13 in the treatment group and 13 in the control group. Children and/or parents were given a 4-h individual instruction program about asthma management by trained nurse educators followed by group discussions and a telephone “hotline” to the educator. The program, like most of the subsequent regimens that will be referred to, included a description of simple pulmonary anatomy, pathophysiology, trigger factors, medications, and allergen avoidance. Outcome measures in this study included school and medical records, symptom diaries, and phone interviews. Remarkably, the treated group showed a tenfold reduction in school absenteeism and a marked decrease in hospital visits and acute exacerbations (p<0.05). The improvement was thought to be due to better comprehension resulting in improved compliance, increased use of prescribed medications, and earlier initiation of therapy during exacerbations.