A Comprehensive Educational Program Improves Clinical Outcome Measures in Inner-City Patients With Asthma

George, Maureen; O'Dowd, L.; Martin, I. R.; Lindell, Kathleen O.; Whitney, Fay W.; Jones, Martha Wilson; Ramondo, Tracey; Walsh, Lynne; Grissinger, Jacqueline; Hansen‐Flaschen, John; Panettieri, Reynold A.

doi:10.1001/archinte.159.15.1710

Cited by 68 publications

(44 citation statements)

References 34 publications

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“…15,16 Improving patients' ability to use inhalers may help prevent adverse events post-hospital discharge, including hospital readmissions. [17][18][19] Although a handful of randomized trials have demonstrated beneficial effects of hospital-based patient selfmanagement education for asthma, [20][21][22][23] these studies employed multi-faceted, time-intensive interventions that were compared to usual care. While this literature encourages the use of hospital-based education, direction is lacking as to which intervention or component is most effective.…”

Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

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BACKGROUND:Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metereddose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p= 0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

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Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

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“…3 Most evaluated inpatient programs have served adults with mixed success. [4][5][6][7] Of hospital-based programs targeting children, 3 were multifaceted and included provider quality improvement activities, education, and support. [8][9][10] Three other studies, each reaching fewer than 100 children, focused primarily on patient/caregiver education and support in the hospital during the child's stay.…”

Section: Introductionmentioning

confidence: 99%

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

Davis

Benson²,

Cooney³

et al. 2011

J Urban Health

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Emergency care and hospitalizations account for 36% of asthma-related medical expenses for children. National asthma guidelines emphasize the need for asthma self-management education at multiple points of care, including the hospital, to help prevent acute exacerbations. The integration of a bedside asthma education program into discharge planning at a busy urban children's hospital aimed to reduce repeat emergency department (ED) visits and hospitalizations by educating the community's highest-risk children and their families about asthma. A trained respiratory professional provided 45 minutes of individualized bedside education to families at the hospital and one follow-up support phone call within 3 weeks after discharge. Children receiving the intervention were matched to a control group of children not receiving the intervention by age and 2 markers of past utilization using data obtained from hospital records. Repeat ED utilization was analyzed using a Cox proportional hazards model controlling for sex, residence, race or ethnicity, and year. Compared to 698 matched controls, no significant improvement was observed in the 698 intervention participants or any subgroups followed for 12 months after the intervention.

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“…30,32 The education provided by these interventions was multifaceted and included in varying degrees: basic disease information, self-management skills, medication information and trigger control. The education was provided in the outpatient, 25 29 or research staff.…”

Section: Intervention Outcomesmentioning

confidence: 99%

“…36 All of the education was provided to the individual participant except for two of the ED-based interventions 28,35 and an outpatient pharmacist based intervention that utilized group sessions. 26 Several provided more than one session, including Galbreath's telephone plus home visit intervention, 29 all three inpatient interventions, [30][31][32] and all but one of the ED studies. 36 Of the 8 studies that followed ED visits, all but two 28,29 demonstrated absolute reductions post-education (22-89 %) 25,31,36 or relative reductions compared to control (16-59 %).…”

Section: Intervention Outcomesmentioning

confidence: 99%

“…36 Of the 8 studies that followed ED visits, all but two 28,29 demonstrated absolute reductions post-education (22-89 %) 25,31,36 or relative reductions compared to control (16-59 %). 30,34,35 The most successful interventions (≥50 % reduction) included two inpatient-based studies provided by a pharmacist 31 or asthma nurse 30 and Bolton's ED multiple-group session intervention. 35 Tatis' specialty clinic with asthma educator intervention 25 and three of four ED-based interventions showed slightly lessimpressive reductions.…”

Section: Intervention Outcomesmentioning

confidence: 99%

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Interventions to Improve Outcomes for Minority Adults with Asthma: A Systematic Review

et al. 2012

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OBJECTIVES:To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma. DATA SOURCES: Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations. Inclusion criteria: adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS:Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes. RESULTS: Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n=14), followed by Latino/a (n=4), Asian Americans (n=1), or a combination of the above (n=5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results. LIMITATIONS: Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. Systemredesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.

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A Comprehensive Educational Program Improves Clinical Outcome Measures in Inner-City Patients With Asthma

Abstract: Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.

Cited by 68 publications

References 34 publications

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

Interventions to Improve Outcomes for Minority Adults with Asthma: A Systematic Review

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