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A randomised trial of self-management planning for adult patients admitted to hospital with acute asthma
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  1. L M Osman1,
  2. C Calder1,
  3. D J Godden2,
  4. J A R Friend2,
  5. L McKenzie3,
  6. J S Legge2,
  7. J G Douglas2
  1. 1Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD, UK
  2. 2Respiratory Medicine Unit, Aberdeen Royal Hospitals, Aberdeen AB25 2ZN, UK
  3. 3Health Economics Research Unit, University of Aberdeen
  1. Correspondence to
    Dr L M Osman, Chest Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
    l.osman{at}abdn.ac.uk

Abstract

Background: There is still debate over the benefit of self-management programmes for adults with asthma. A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission.

Method: A randomised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months. Patients on the self-management programme (SMP) received 40–60 minutes of education supporting a written self-management plan. Control patients received standard care (SC).

Results: One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze (OR 2.6, 95% CI 1.5 to 5.3), no night disturbance (OR 2.0, 95% CI 1.2 to 3.5), and no activity limitation (OR 1.5, 95% CI 0.9 to 2.7). Over 12 months 17% of SMP patients were re-admitted compared with 27% of SC patients (OR 0.5, 95% CI 0.3 to 1.0). Among first admission patients, OR readmission (SMP v SC) was 0.2 (95% CI 0.1 to 0.7), p<0.01. For patients with a previous admission, OR readmission was 0.8 (95% CI 0.4 to 1.6), p=0.6. SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge (99% v 92%, p=0.03), oral steroids (98% v 90%, p=0.06), and to have hospital follow up (98% v 84%, p<0.01) but adjustment for these differences did not diminish the effect of the self-management programme.

Conclusions: A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients. The benefit of the programme may have been greater for patients admitted for the first time. The programme also had a small but significant effect on medical management at discharge.

  • asthma
  • self-management
  • readmission

https://doi.org/10.1136/thorax.57.10.869

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    Footnotes

    • ↵* Among the 12 patients admitted more than 10 years ago and included in the “multi” admission group were two control patients who were readmitted. No intervention patients were readmitted. We judged that inclusion of the 12 patients in the “multi” group was the most conservative approach to analysis.

    • Liesl Osman contributed to the study design, co-led the evaluation, carried out most of the statistical analysis, and prepared the manuscript for publication. Christine Calder contributed to the study design, carried out the self-management planning programme, carried out some of the analysis, and helped prepare the manuscript for publication. Graham Douglas contributed to the study design, co-led the evaluation, and helped prepare the manuscript for publication. David Godden contributed to the study design and helped prepare the manuscript for publication. James Friend contributed to the study design and helped prepare the manuscript for publication. Joseph Legge contributed to the study design. Lynda Mckenzie contributed to the design of the study and the evaluation.

    • Liesl Osman, Christine Calder, Graham Douglas are guarantors for the paper.

    • The study was funded by the NHS R & D Programme in Delivery of Care in Asthma, managed by the National Asthma Campaign. The Health Economics Research Unit is funded by the Chief Scientist Office, Scottish Executive Health Department. The views expressed in this paper are those of the authors and not those of the funding bodies.

    • Conflicts of interest: none.