Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland

Abstract

Objective: To evaluate the READER model for critical reading by comparing it with a free appraisal, and to explore what factors influence different components of the model. Design: A randomised controlled trial in which two groups of general practitioners assessed three papers from the general practice section of the BMJ. Setting: Northern Ireland. Subjects: 243 general practitioners. Main outcome measures: Scores given using the READER model (Relevance, Education, Applicability, Discrimination, overall Evaluation) and scores given using a free appraisal for scientific quality and an overall total. Results: The hierarchical order for the three papers was different for the two groups, according to the total scores. Participants using the READER method (intervention group) gave a significantly lower total score (P<0.01) and a lower score for the scientific quality (P<0.0001) for all three papers. Overall more than one in five (22%), and more men than women, read more than 5 articles a month (P<0.05). Those who were trainers tended to read more articles (P<0.05), and no trainers admitted to reading none. Overall, 58% (135/234) (68% (76/112) of the intervention group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future (P<0.01). Conclusion: Participants using the READER model gave a consistently lower overall score and applied a more appropriate appraisal to the methodology of the studies. The method was both accurate and repeatable. No intrinsic factors influenced the scores, so the model is appropriate for use by all general practitioners regardless of their seniority, location, teaching or training experience, and the number of articles they read regularly.

Evaluation of a Quality Improvement Collaborative in Asthma Care: Does it Improve Processes and Outcomes of Care?

“…Finally, in an intervention that emphasized peak fl ow monitoring, Lahdensuo et al found that patients with the intervention had signifi cantly fewer direct medical costs, fewer unscheduled outpatient visits, and fewer work days missed because of asthma-related illness, as well as a signifi cantly better quality of life. 25,26 Overall, our fi ndings on process of care are similar to the fi ndings obtained for the pediatric population in the same study. 27 For the pediatric population more effects were signifi cant because the sample sizes were larger.…”

National and regional asthma programmes in Europe

“…In the mid-1990s, early randomised studies showed that guided self-management with patients' own adjustment of anti-inflammatory medication based on symptoms and home peak flow measurements reduced exacerbations and other asthma events compared with traditional therapy [72]. This also resulted in reduced asthma care costs [73]. A systematic review of 36 trials found guided self-management of asthma in adults to be clearly advantageous compared with usual care and to significantly improve patients' health [74].…”

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

“…Moreover, such a system has the potential to improve patients' compliance to treatment. Guided management of allergic diseases including asthma was found to be effective (46,47) with clear evidence provided by the Finnish Asthma Programme (48) and the Allergy Programme (49,50).…”