Impact of patient education and self-management on morbidity in asthmatics and patients with chronic obstructive pulmonary disease

Abstract

The effect of patient education on morbidity in asthmatics and COPD patients has not previously been investigated in a single study. We randomized 78 asthmatics and 62 COPD patients after ordinary outpatient management. Intervention consisted of educational group sessions and individual sessions administered by a trained nurse and physiotherapist. A self-management plan was developed. The utilization of health resources and absenteeism from work was self-reported monthly. During the 12-month follow-up, approximately two (P= 0.001) and three (P= 0.001) times as many uneducated asthmatics and COPD patients, respectively, visited their general practitioner (GP) compared with educated. The mean reduction in GP consultations for the educated were 73% (P<0.001) and 85% (P<0.0001) for the asthma and COPD group, respectively, compared with uneducated. Fifty percent of uneducated asthmatics reported absenteeism from work compared with 24% of the educated (P = 0.06). The mean reduction in days offwork for the educated was 69% (P = 0.03), compared with uneducated. A positive correlation was observed between St George's Respiratory Questionnaire total score and number of GP visits for both the asthma and COPD group (P < 0.001). We conclude that patient education in asthmatics and COPD patients reduced the need for GP visits and kept a greater proportion of patients independent of their GP. Patient education among asthmatics also reduced the number of days off work and appeared to increase the proportion of patients not reporting absenteeism from work at all. Increasing number of GP visits was correlated with decreased health-related quality of life as measured by the SGRQ for both the asthmatics and the COPD patients.

Prevalence of asthma-triggering drug use in adults and its impact on asthma control

“…This can be a critical cause of PAC, emergency room visits, and continuous asthma morbidity. 7 The present findings reflect the unacceptably low awareness of health professionals about the harmful effects of ATDs on asthma control levels. Regular asthma educational courses to health professionals would be an effective strategy to improve this awareness.…”

Cost-effectiveness of self-management in asthmatics: a 1-yr follow-up randomized, controlled trial

“…The skewed distribution The mean number of GP visits, pulmonary physician visits and days off work in the control group were 2.6, 0.2 and 20.5, respectively. The corresponding figures for the intervention group were 0.7, 0.2 and 6.0 [17]. Median values with 25th and 75th percentiles are shown due to the skewed distribution of data.…”

“…Both Health Related Quality of Life (HRQoL) and symptom data have been recommended as important effectiveness measures in the management of asthma and have been found to correlate well with pulmonary function measures [5]. Other less important alternatives of comparison, as previously published [16,17], could have been tested, but recommendations for cost-effectiveness analyses advise unidimensional designs [20].…”

“…The patients reported monthly GP visits due to asthma [17], using standardized registration forms and self-addressed, stamped envelopes. Detailed information on date, time and duration of consultation, name of the doctor, pulmonary function tests and personal costs by the patient was received, and the costs set according to the NHI fee schedule [25].…”

“…The present asthma education programme has been shown, in a 12 month follow-up, to improve quality of life, level of lung function [15] and compliance to inhaled corticosteroids [16] as well as reducing GP consultation rates and absenteeism from work [17] due to asthma. Based on these data, estimated the costeffectiveness ratios of patient education choosing St. George9s Respiratory Questionnaire (SGRQ) total score, FEV1 and number needed to educate (NNE) to make one person symptom free as clinically important effectiveness measures were calculated.…”