Standardversuspatient-centred asthma education in the emergency department: a randomised study

Abstract

High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain. The present study aimed to compare the effectiveness of patient-centred education (PCE) and standard asthma patient education on ED re-attendance.A randomised controlled trial was conducted at two inner-city Australian teaching hospitals' EDs, where patients received either standard patient education (SPE) or PCE. Both groups received a six-topic curriculum. However, PCE patients reordered the topics according to their own priority and thus controlled the order of education.In total, 146 adult patients presenting to EDs with acute asthma were enrolled. After 4 months, ED re-attendance decreased from 22 to 12% in the PCE group and remained unchanged in the SPE group (between group odds ratio 0.4, 95% confidence interval (0.2-1.1)). In 78 patients discharged after ED care, the PCE group had fewer re-attendances after 4 and 12 months (0.3 (0.1-0.9) and 0.3 (0.1-0.8), respectively ). PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months (0.1 (0.0-0.7) and 0.2 (0.0-0.6), respectively). A trend of better asthma control was evident, with a reduction in activity limitation.In conclusion, patient-centred education offers promise as a brief education process in the emergency department. However, a large multicentre trial of patient-centred education is required.

The influence of personality traits and beliefs about medicines on adherence to asthma treatment

“…13,17 The most adherent individuals are those who accept the necessity of medication and have low concerns about potential adverse consequences. 17,24 A study by Smith, Mitchell and Bowel 36 showed that a patient-centred asthma education programme led to fewer health care re-attendances than a standardised education programme. In our opinion, personality traits could be used to guide efforts to educate asthma patients.…”

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

“…The physician's empathy, good interpersonal exchange, and greater fairness in the treatment process have led to higher levels of patient activation (Alexander et al 2012;Hojat et al 2011), while improved patient activation itself has been associated with higher medication adherence (Parchman et al 2010). Several studies have shown that appropriate patient education can help patients gain control over complex diseases (Casas et al 2006;Clark et al 2000;Smith et al 2008;Snow et al 2013;Sperl-Hillen et al 2011), to feel more independent from medical advice (Snow et al 2013), and leads to improved quality of life (Koff et al 2009). …”

“…Informational needs were reduced by assessing the patients' information preferences, and fulfilled informational needs resulted in higher patient satisfaction (Thoonen et al 2002). Better provision of information and patient educa- tion had a significant impact on the patients' health status (Bhattacharyya et al 2010;Cabana et al 2006;Casas et al 2006;Clark et al 2000;Smith et al 2008;Sperl-Hillen et al 2011;Yilmaz & Akkaya 2002), on compliance (Bhattacharyya et al 2010;Kostev et al 2014;van Ganse et al 2003), and on quality of life (Aiarzaguena et al 2007;Dibbelt et al 2010;Koff et al 2009;Mackenzie et al 2013;Martinez-Moragon et al 2014). Moreover, better patient education did not result in more time spent with the patients than usual care in the long run (Clark et al 2000).…”

Patient-centred asthma education in the emergency department: the case in favour

“…The work that has gone into that study cannot be underestimated; one researcher educated all patients irrespective of the time of day or night that they attended. Asthma studies of any sort are notoriously difficult in terms of recruitment and retention; SMITH et al [18] are constrained in their conclusions but correctly say that there is certainly enough evidence to justify a further large, multicentre study and the patient-centred approach to education, which intuitively appears to be correct, looks promising. If further trials confirm the benefit of this approach, thought will need to be given to the logistics involved in delivering such care for 24 h, 7 days a week, and further health-economic analysis will be needed as well as comparison with other types of nurse-led intervention [12].…”

“…Valuing the patient to the extent that the approach is tailored to what is important to them seems intuitively to be far more likely to lead to success, rather than imposing upon them a set of information which we believe to be important. Therefore, the approach by SMITH et al [18], in the current issue of the European Respiratory Journal, is to be welcomed. The work that has gone into that study cannot be underestimated; one researcher educated all patients irrespective of the time of day or night that they attended.…”