Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training

Objective

To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents.

Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative study

BACKGROUND: National and international healthcare policy increasingly seeks technological solutions to the challenge of providing care for people with long-term conditions. Novel technologies, however, have the potential to change the dynamics of disease monitoring and self-management. We aimed to explore the opinions and concerns of people with asthma and primary care clinicians on the potential role of mobile phone monitoring technology (transmitting symptoms and peak flows, with immediate feedback of control and reminder of appropriate actions) in supporting asthma self-management. METHODS: This qualitative study recruited 48 participants (34 adults and teenagers with asthma, 14 asthma nurses and doctors) from primary care in Lothian (Central Scotland) and Kent (South East England). Thirty-nine participated in six focus groups, which included a demonstration of the technology; nine gave in-depth interviews before and after a 4-week trial of the technology. RESULTS: Participants considered that mobile phone-based monitoring systems can facilitate guided self-management although, paradoxically, may engender dependence on professional/technological support. In the early phases, as patients are learning to accept, understand and control their asthma, this support was seen as providing much-needed confidence. During the maintenance phase, when self-management predominates, patient and professionals were concerned that increased dependence may be unhelpful, although they appreciated that maintaining an on-going record could facilitate consultations. CONCLUSION: Mobile phone-based monitoring systems have the potential to support guided self-management by aiding transition from clinician-supported early phases to effective self-management during the maintenance phase. Continuing development, adoption and formal evaluation of these systems should take account of the insights provided by our data.     

Long-term effects of a peer-led asthma self-management program on asthma outcomes in adolescent peer leaders

ObjectiveTo examine the long-term effects of a peer-led asthma self-management program on urban adolescent peer leaders with asthma.MethodsThis longitudinal study includes 51 adolescents (16?20 years) enrolled in an asthma self-management program implemented at a one-day camp as peer leaders. Study outcomes, including quality of life, asthma control, asthma knowledge, and attitudes toward asthma were collected for 15 months post-intervention. Mixed-effects models were conducted to estimate time effects, and effect sizes were calculated for each model.ResultsOf 51 enrolled, 41 completed the training, of which 35 successfully participated in the camp program. A total of 17 peer leaders withdrew between enrollment and 15-months follow-up. Quality of life, asthma control, and knowledge significantly improved after peer leader training and remained elevated for 15 months, while significant improvement in attitudes emerged immediately after camp, in which they served as leaders, and sustained for 15 months.ConclusionThis study demonstrates the long-term positive effects of a peer-led program on a wide range of asthma outcomes in urban adolescent peer leaders.Practice ImplicationsA peer-led approach to asthma education providing peer leaders with intense training and leadership experience can be effective and sustainable in improving asthma outcomes among urban adolescents.     

Do self-management plans reduce morbidity in patients with asthma?

BACKGROUND: Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks. AIM: A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma. METHOD: General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans. RESULTS: In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators. CONCLUSION: General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'.     

Setting priorities: Nationwide nosocomial infection prevention and control programs in the USA

Approximately two million nosocomial infections occur annually in patients admitted to acute-care hospitals in the USA. Factors that should be considered in setting national priorities for nosocomial infection prevention and control efforts include incidence, mortality, prolongation of stay, cost of treatment, and potential for prevention of infections at different sites. National nosocomial infection priorities in the USA cover infections caused by emerging pathogens, infections at selected sites including the bloodstream, infections in intensive-care units, infections resulting from contaminated devices and products, development of the capability to analyze surveillance data in a timely fashion, dissemination of information on effective prevention strategies to infection control personnel, and training of infection control personnel, including physicians. The mechanism used to disseminate information on effective prevention strategies is the series of CDC Guidelines for the Prevention and Control of Nosocomial Infections. These guidelines address prevention of nosocomial infections at the four major sites, handwashing and environmental control issues, infection control in personnel health, and isolation precautions.     

Effects of a self-management educational program for the control of childhood asthma

The objective of the present study was to evaluate the effects of a self-management educational program on 29 children between 6 and 14 years old and their parents implemented in an office setting in Venezuela. Children were randomly assigned to experimental and control group. Children's asthma knowledge, self-management abilities, index morbidity, parents' asthma knowledge and management abilities were measured. The program consisted of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and an informative brochure for the parents. Results of t tests indicate that the experimental group experienced a statistical significant effects on children's asthma knowledge (P < 0.001) and practice of self-management abilities (P < 0.000) and in parents' knowledge (P < 0.008) compared to the control group. The educational Self-management program had a significant impact on the Morbidity Index of the study group at post-test (P < 0.05). Younger children benefited more from the program compared to older ones (P < 0.09). Children's age is highlighted as a critical variable in designing asthma educational programs. Results suggest the effectiveness on these programs independently of the cultural context.     

Vaccine presentation in the USA: economics of prefilled syringes versus multidose vials for influenza vaccination

In the USA, influenza vaccines are available as parenteral injections or as an intranasal preparation. Injectable influenza vaccines are available in either multidose vial (MDV), single-dose vial or prefilled syringe (PFS) presentations. PFSs have gained market share in the USA but have not yet reached the levels of uptake currently seen in Western Europe. Here, we review the topic of vaccine presentation in the USA, with a special focus on influenza vaccines. Second, we present the results of a time-motion study that measured administration costs of influenza vaccination comparing MDVs versus PFSs during the 2009/2010 influenza campaign. Vaccinating with MDVs took an average 37.3 s longer than PFSs. The cost of administering 1000 immunizations in 2009 using MDVs were US$8596 versus US$8920.21 using PFSs. In a pandemic situation where 300 million Americans would require vaccination, PFSs would save 3.12 million h in healthcare worker time, worth US$111.1 million. The higher acquisition costs of PFS vaccines compared with MDVs are offset by lower administrative costs and increased safety.     

House dust mite allergen avoidance and self-management in allergic patients with asthma: randomised controlled trial

BACKGROUND: The efficacy of bed covers that are impermeable to house dust mites has been disputed. AIM: The aim of the present study was to investigate whether the combination of 'house dust mite impermeable' covers and a self-management plan, based on peak flow values and symptoms, leads to reduced use of inhaled corticosteroids (ICS) than self-management alone. DESIGN OF STUDY: Prospective, randomised, double blind, placebo-controlled trial. SETTING: Primary care in a south-eastern region of the Netherlands. METHOD: Asthma patients aged between 16 and 60 years with a house dust mite allergy requiring ICS were randomised to intervention and placebo groups. They were trained to use a self-management plan based on peak flow and symptoms. After a 3-month training period, the intervention commenced using house dust mite impermeable and placebo bed covers. The follow-up period was 2 years. Primary outcome was the use of ICS; secondary outcomes were peak expiratory flow parameters, asthma control, and symptoms. RESULTS: One hundred and twenty-six patients started the intervention with house dust mite impermeable or placebo bed covers. After 1 and 2 years, significant differences in allergen exposure were found between the intervention and control groups (P<0.001). No significant difference between the intervention and control groups was found in the dose of ICS (P = 0.08), morning peak flow (P = 0.52), peak flow variability (P = 0.36), dyspnoea (P = 0.46), wheezing (P = 0.77), or coughing (P = 0.41). There was no difference in asthma control between the intervention and control groups. CONCLUSION: House dust mite impermeable bed covers combined with self-management do not lead to reduced use of ICS compared with self-management alone.     

Health technology assessment of asthma disease management programs

PURPOSE OF REVIEW: To provide a critical opinion on the extent to which asthma disease management programs currently improve the effectiveness and efficiency of care and directions for future policy and research. RECENT FINDINGS: The methodological quality of health technology assessment of asthma disease management programs remains moderate. Asthma disease management programs are predominantly educational and organizational in nature and focus either on children or on adults. Paediatric disease management programs make more effort to outreach into patients' living environments and show higher participation rates than those targeting adults. Reductions in asthma-related hospitalization, emergency department, and unplanned clinic visits range from 0 to 85%, 87% and 71%, respectively. Aspects of self-management and organization of care improved after the implementation of disease management programs. Almost no impact on asthma symptoms, lung function or the use of long-term control medication was found. SUMMARY: There is accumulating 'circumstantial' evidence that disease management programs reduce resource utilization. The analytical rigor and uniformity of health technology assessment of asthma disease management programs has improved, but the generalizability of results remains uncertain. Practical, multicentre, clinical trials including broad representative study samples should be performed in different settings to increase methodological quality and substantiate current findings.     

Effect of educational programs on asthma control and quality of life in adult asthma patients

This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent asthma we tested the benefit of individual verbal instructions (IVI), written information ("asthma booklet", B), and integrated asthma classes ("asthma school", AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.     

Adapting a self-management education program for asthma for use in an outpatient clinic

A self-management patient education program for children with asthma which incorporates a slide tape program, pamphlets, nurse discussion, and physician discussion has been adapted from an emergency room site to an outpatient clinic for use during routine asthma clinic visits. Pre-interviews and post-interviews with and medical record review of 12 patients, aged 4 to 12 years, demonstrated that the children had statistically significant increases in knowledge of self-management skills (recognition of asthma triggers and early warning signs and appropriate behaviors to manage acute episodes) and a significant increase in the sense of personal control (Health Locus of Control). Parents reported less disruption of family activities due to asthma and that the children had increased their use of asthma self-management techniques, resulting in improved management of asthma at home. Nurse and physician response to the program was enthusiastic and demonstrated the feasibility of integrating patient education into the outpatient clinic medical care routine.     

Asthma education tailored to individual patient needs can optimise partnerships in asthma self-management

This paper studies the effects of patient education, tailored to individual needs of patients as part of an asthma self-management program. A tailored education program was designed which took into account individual information needs of patients by using a feedback instrument. Totally 98 steroid dependent asthmatics entered the tailored education program, 95 patients received usual care. Outcome measures were information exchanged and patient satisfaction. Study duration was 6 months. Patients in the tailored education group showed a significant reduction in information need (P=0.005). Patient satisfaction increased from 87.9 to 93.7 in this group while this did not change in the usual care group (P=0.000). Use of this tailored education program improved the GP-patient interaction within the context of a clinically effective asthma self-management program. Findings from this study may be applicable to other chronic conditions as well.     

Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma.

BACKGROUND: Improving asthma knowledge and self-management is a common focus of asthma educational programs, but most programs have had little influence on morbidity outcomes. We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care. OBJECTIVE: To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk, school-aged children with asthma. METHODS: We enrolled 119 children aged 5 to 12 years from low-income, urban areas in and around San Francisco, CA, and San Jose, CA. Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were randomized to participate in the disease management intervention or to receive their usual care (control group). Patients were evaluated for clinical and quality-of-life outcomes at weeks 8, 32, and 52 of the study. RESULTS: Compared with controls, the intervention group had significant improvements in the physical domain (P = .04 and P = .01 at 32 and 52 weeks, respectively) and social activity domain (P = .02 and P = .05 at 32 and 52 weeks, respectively) of asthma quality of life on the Child Health Survey for Asthma and child (P = .02 at 8 weeks) and parent (P = .04 and .004 at 32 and 52 weeks, respectively) asthma self-management knowledge. There were no significant differences between groups on clinical outcome variables. CONCLUSIONS: A multicomponent educational, behavioral, and medical intervention targeted at high-risk, inner-city children with asthma can improve asthma knowledge and quality of life.     

Life-threatening asthma and anaphylaxis in schools: a treatment model for school-based programs.

BACKGROUND: Pediatric asthma is the No. 1 chronic disease in childhood and is responsible for significant morbidity and mortality. In Nebraska, the number of asthma-related deaths is greater than the national average, and in 1998, 2 students died of acute asthma attacks while attending school in the Omaha public schools (OPSs). In response, we designed and implemented a program to respond to this problem. OBJECTIVE: To implement and study a school-based program for the treatment of life-threatening asthma and anaphylaxis in the OPSs. METHODS: The Emergency Response to Life-Threatening Asthma or Systemic Allergic Reactions (Anaphylaxis) Protocol was designed and evaluated in 78 OPSs from 1998 to 2003. Nurses and school staff were trained in the protocol, which required the use of nebulized albuterol and/or intramuscular epinephrine in conjunction with an emergency response procedure. Outcomes were measured by improvement in acute care in schools and survival of students. Results: In the 5 years of evaluation, 98 students were treated successfully. One student died. Of those treated with the protocol, equal numbers had at school both asthma action plans (AAPs) and metered-dose inhalers (MDIs), MDIs only, or neither AAPs nor MDIs. As a result of the program, there has been an increased awareness from parents, teachers, and physicians about the necessity of an emergency response program. In 2002, an outcome of the OPS program resulted in the formation of Attack on Asthma Nebraska to ensure that Nebraska schools have the education, training, and medications to respond to anyone experiencing a life-threatening asthma or anaphylaxis attack at school. The following year, a revised protocol was approved by the Nebraska State Board of Education for use in all Nebraska schools. CONCLUSIONS: Emergency response protocols provide protection for children while in school. This program should serve as a national model for other school-based programs for children and adolescents with asthma and anaphylaxis.     

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Objective

This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization.

Methods

Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization.

Results

Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p = 0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm.

Conclusion

CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM.

Practice implications

Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients.     

Perceptions of asthma in South Asians and their views on educational materials and self-management plans: a qualitative study

Asians with asthma have higher hospital admission rates than whites without any evidence of increased asthma severity. There is limited information as to whether these differences are due to language or communication difficulties, variable knowledge and cultural attitudes to asthma or deficiencies of medical care. A qualitative study with 60 participants (12 participants with asthma for semi-structured interviews and 48 participants for focus groups) was designed to explore knowledge about asthma, attitudes, perceptions, health beliefs and health needs of those from Pakistan and India (South Asians). Overall, most of the patients with asthma were aware of the symptoms and trigger factors of asthma and were well informed about the 'reliever' and 'preventer' properties of their inhalers. They were also well informed about alternative/complementary therapies and were willing to try them should the treatment provided by their general practitioner (GP) fail to resolve their symptoms. Most were dissatisfied with the asthma care provided by their GPs e.g. delays in making the diagnosis and deficiencies in providing both verbal and written information on asthma. There was lack of awareness about self-management plans although when explained, the concept of self management was well received and there was approval for the concept of written action plans. All the focus group participants seemed to know something about asthma and amongst those with the condition (or with relatives with the condition), knowledge of the disease and its treatment seemed to be good. It was concluded that improved dissemination of written and verbal information on all aspects of asthma and increased awareness, training and support for adoption of written self-management (action) plans is needed to provide a more efficient and effective service for South Asian patients with asthma.