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

doi:10.1016/S0738-3991(02)00015-0

Patient Education and Counseling

Volume 47, Issue 4, August 2002, Pages 355-360

https://doi.org/10.1016/S0738-3991(02)00015-0 Get rights and content

Abstract

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.

Introduction

Management of chronic diseases has changed during the last few decades. Especially the introduction of evidence based guidelines caused a shift from symptom based management towards disease management [1], [2], [3], [4]. Specific aspects of chronicity like relapse prevention, maintenance therapy and scheduled follow-up have led to changes in the long-term outcome of chronic diseases. But the apparent gap between effectiveness and efficacy demonstrates that other factors than adequate diagnostics and therapy may determine the success of chronic disease management. One factor that remains underestimated in most studies is the role of the patient in terms of adherence to any given treatment program or advice. A suitable tool to alter adherence is appropriate patient education combined with skills training and a self treatment plan [5], [6], [7], [8], [9]. A major problem regarding patient education however is the discrepancy between what the patient needs to know according to the health professional and what the patient wants to know on the basis of own interests or previous knowledge. Patient education aimed at improving compliance is often based on the aforementioned ‘need to know’ basis and has the potential risk of becoming yet another way of pursuing professional objectives [10]. This makes it obvious that patient-education should be tailored to individual needs.

One of the chronic conditions in which success of a structured disease management plan depends greatly on adherence and involvement of patients is asthma. Previously to this study 28 relevant topics (‘need to know’) for asthma education were identified by a panel of GP’s, based on a Delphi consensus procedure [11]. As part of an asthma self-management plan a stepwise education program was designed, based on these topics. This asthma self-management program improved quality of life and asthma control [12], [13]. In terms of cost-effectiveness it proved to be a dominant treatment strategy [14]. Patients were given a tool to indicate to the GP what they wanted to know themselves about their asthma (feedback) and thus influenced the contents of their own asthma education. Because of the increased involvement of the patient in his or her own education this approach was called tailored education. The objectives of the tailored education program were to provide asthma education as defined by the Delphi procedure and to meet the specific information need of the patient as well. To find out if this could be achieved we studied if use of feedback by patients led to a decrease in information needs of patients. We also investigated if the education program led to changes in satisfaction of patients with the treatment of asthma as provided by their GP.

Section snippets

Study design

Main outcome measures of the education program were changes in patient satisfaction and the information need of patients. The design of the study is schematically summarised in Fig. 1.

A total number of 19 practices participated in this study. Self-management intervenes in the interaction between health care professionals and their patients. To prevent contamination within family practices it was therefore considered important that all patients in each practice received the same treatment.

Sample

After the selection procedure 214 eligible patients were included, 104 in the usual care group and 110 in the tailored education group. In the tailored education group seven patients did not start with the program and five patients decided to stop during the education program. As a result 98 patients completed the education program. In the usual care group eight patients did not start and one patient decided to stop, leaving 95 patients. Baseline characteristics of patients completing the

Discussion

Results of this study show that GPs are able to reduce the information needs of asthma patients using feedback of information needs, resulting in a higher patient satisfaction. This is also reflected in the decrease of the need for additional information as described for each separate item in Table 3.

A similar approach was tested by Cegala et al. [22], [23]. They provided patients with tools to make a systematic inventory of their information needs combined with a communication-training

Acknowledgements

This research project has been made possible by research grants from The Netherlands Organization for Scientific Research (NWO) and ASTRAZeneca Pharmaceutica BV.

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Healthcare burden of obstructive sleep apnea and obesity among asthma hospitalizations: Results from the U.S.-based Nationwide Inpatient Sample
2016, Respiratory Medicine
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Asthma comorbidities were not significantly associated with disposition for males in our study. The literature has elucidated significant comorbidity of obesity [4,22,23] and obstructive OSA [11,12,24,25] among those with asthma, though studies evaluating the impact of such comorbidities on inpatient and hospital outcomes remain limited. In this study, we addressed such a gap in the literature by utilizing the largest publically available inpatient data in the United States, to assess the role of such asthma comorbidities on health resource utilization (length of stay and total charges), need for respiratory therapy, and patient disposition status among those hospitalized for asthma.
Studies have highlighted the significant comorbidities of both obesity and obstructive sleep apnea (OSA) among asthma patients in outpatient settings, but such data in the inpatient setting is sparse.
Using 2009–2011 U.S. Nationwide Inpatient Sample; survey-weighted regression analyses were conducted to address the role of obesity, OSA, and both obesity and OSA on length of stay (LOS), total hospital charges, need for respiratory therapy, and disposition among adults with primary asthma hospitalization (n = 179,789).
Males had a higher prevalence of OSA than females (5.23% vs. 3.88%), while females had a higher prevalence of obesity (17.21% vs. 8.95%) and both obesity and OSA (7.11% vs. 6.19%). Increased hospital LOS was associated with presence of obesity (incidence rate ratio [IRR] males = 1.07, IRR females = 1.08), OSA (IRR males = 1.07, IRR females = 1.14), and both obesity and OSA (IRR males = 1.19, IRR females = 1.24). Increased total hospital charges was related to obesity (8.64% for males and 9.61% for females), OSA (15.39% for males and 19.13% for females), and both comorbidities (24.94% for males and 28.50% for females). Presence of OSA alone increased odds of need for respiratory therapy for males (odds ratio [OR] = 2.56) and females (OR = 3.22), as did presence of both comorbidities (OR males = 2.85, OR females = 3.60). Odds of routine disposition was lower among females with both comorbidities (OR = 0.82).
Compared to obesity alone, OSA and both obesity and OSA are associated with increased health resource utilization and poorer inpatient outcomes. This demonstrates the need for further clinical investigations of early detection of OSA among such at-risk populations.
What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review
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The support needs for self-management of rheumatoid arthritis patients described in this study correspond with the support needs of patients with other chronic conditions as described in several studies. Patients with a coronary heart disease, stroke, or asthma express information needs with regard to taking their medications, such as information about side-effects, short- and long-term effects, and interaction effects (Barber et al., 2004; Pier et al., 2008; Raynor et al., 2004; Thoonen et al., 2002). Additionally, in the study by Pier et al. (2008), patients express an information need in relation to performing physical exercises.
Self-management support is essential to perform self-management behavior. To provide this support in an effective way, insight in the needs for self-management support is necessary.
To give an overview of self-management support needs from the perspective of rheumatoid arthritis patients to help nurses to improve self-management.
We conducted a scoping review for the period of January 2002 to May 2013 using the following inclusion criteria: (1) studies on adult patients aged 18 years and older, (2) studies from the perspective of rheumatoid arthritis patients, (3) studies reporting results on support needs, and (4) empirical studies using any design.
We searched in PubMed, CINAHL, and PsycINFO.
Following the steps of a scoping review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, (4) charted the data, and (5) collated, summarized, and reported results. We incorporated the optional sixth step of consultation of a multidisciplinary panel of professionals and patients to validate our findings.
Seventeen articles were included. Our review shows that rheumatoid arthritis patients have informational, emotional, social and practical support needs. We found an information need for various topics, e.g. exercises and medication. Patients express a need for emotional support in daily life, given through other RA patients, colleagues and supervisors and nurses. For information needs, emotional and social support it is important that it is tailored to the individual needs of the patient.
The most important support needs for self-management mentioned by rheumatoid arthritis patients are more informational, social and practical support and emotional support.
Considering patients’ perspective as a starting point for delivering support for self-management can lead to the development of nursing interventions tailored to the needs of rheumatoid arthritis patients.
Asthma self management in adults: A review of current literature
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Citation Excerpt :
How such programs are provided, however, is varied and diverse – including group learning sessions, provision of written materials and computerized education programs just to name a few (McDonald & Gibson, 2006). The delivery of asthma self management education programs has also been reported from settings such as hospitals (Allen, Jones, & Oldenburd, 1995; Osman et al., 2002) and GP surgeries (Thoonen et al., 2002). Community pharmacists and pharmacies have also shown to be effective delivery settings for asthma self management education (Barbanel, 2003; Kritikos, Reddel, & Bosnic-Anticevich, 2010; Smith, Mitchell, & Bowler, 2007).
Self management programs for chronic conditions, such as asthma, have an important place in healthcare delivery. When properly implemented, they can curb the impact of disease and reduce both the high personal costs for individuals and significant financial costs for health care systems. The purpose of this review was to establish an understanding of current published literature on asthma self management programs in adults and to identify any reported attributes or components which serve to either assist or obstruct the uptake of self management strategies. Electronic data sources including Scopus, Proquest 5000, CINAHL, PubMed and Web of Science were accessed and literature searches were conducted using the key terms: asthma, chronic disease, self management, morbidity, quality of life, health outcomes, patient education and best practice. Inclusion criteria for the search included journal articles relating to adults with asthma published in English in peer reviewed journals from 1995 to 2011. Exclusion criteria included research targeting children, parents of children or families; and articles examining Asthma and COPD (or any other co-morbidity). Sixty four articles were included in this review due to their relevance to the major components of asthma self management, as defined by the Australian Asthma Management Handbook. A major conclusion from this review was that the uptake of asthma self management strategies is poor despite global recommendations for over twenty years; and that a likely reason for this is that generic asthma self management advice does not engage the individual with asthma.
Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained
2011, Patient Education and Counseling
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These could represent areas for future focus in pharmacist delivered asthma education, although of course such needs could be different in different settings. In similar studies in other healthcare professions, for example in general practitioners, it has been shown that tailored education is more effective at reducing the information needs of the patient, as compared to usual care [48]. This study also addressed the need for resource allocation in asthma education delivery and design.
To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients’ perceptions about any changes in their knowledge.
Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients’ perceptions of the impact of the service on their knowledge were explored qualitatively in interviews.
The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n = 561, to 8.78 ± 2.14, n = 393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma.
Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions.
Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community.
Health information needs and expectations from the user's perspective
2008, Revista de Calidad Asistencial
La necesidad de información en salud está ampliamente reconocida. El objetivo de este estudio es conocer cómo se recibe y cómo se valora la información sanitaria que se obtiene actualmente, y explorar en la identificación de necesidades y expectativas de la ciudadanía andaluza sobre este tema.
Metodología cualitativa basada en entrevistas semiestructuradas realizadas por teléfono. Se realizaron 48 entrevistas con personas que responden a diferentes perfiles teóricos sociosanitarios a partir de una muestra estructural. La selección final de las personas a entrevistar se formalizó siguiendo el muestreo de “bola de nieve”. Se realizó un análisis de contenido apoyado del programa informático NUDIST Vivo versión 1.1.
Las personas entrevistadas manifiestan recibir información sanitaria principalmente del personal sanitario. También señalan hacer uso de otras fuentes de información de manera complementaria, como internet, publicaciones y asociaciones. Hay diferentes grados de satisfacción respecto de la información sanitaria recibida según el grado de comprensión y profundidad que ésta aporte. Se pretende recibir toda la información posible relacionada con el proceso de salud-enfermedad-atención, así como que esta información sea transmitida principalmente por profesionales de la medicina.
Es deseable que la información sanitaria se centre en los aspectos prácticos del proceso salud-enfermedad-atención. El personal facultativo es el principal referente de información en salud, por lo que es aconsejable la promoción de actividades formatives en habilidades de comunicación en este grupo profesional. Además, se recomienda reforzar cauces alternativos que ofrezcan a la ciudadanía información sanitaria de calidad.
Patients’ need for health information is widely recognized. The aim of this study was to determine how patients currently receive and rate this information. Additionally, we aimed to identify the needs and expectations of citizens of the autonomous region of Andalusia in this regard.
We performed a qualitative research study involving semi-structured telephone interviews with participants. A total of 48 interviews were performed in people with different social and health profiles from a structural sample. The final selection of persons to be interviewed was made using the snow-ball sampling method. Interview material was analyzed by means of NUDIST vivo 1.1 software-aided content analysis.
The interviewees reported receiving health information mainly from healthcare personnel. Supplementary information sources were the internet, associations and publications. The interviewees expressed different degrees of satisfaction with the health information received, depending on its understandability and the amount of detail provided. The persons interviewed reported that they would like to receive all the information possible on their health-illness-care process and would prefer this information to come mainly from physicians.
Information about the health-illness-care process should center on practical issues. Physicians are the first and principal source of medical information and consequently communication skills should be promoted in this collective through training courses. Additionally, alternative sources of information used by citizens should be strengthened to provide high-quality health information.
Patient satisfaction with different asthma-training variants
2008, Patient Education and Counseling
Information on patient satisfaction with professional health care delivery in asthmatics is rare, and the question as to how asthma education programmes affect such satisfaction has not yet been addressed.
This multi-centre study investigated three different variants of an asthma education programme for adults. Patients participated either in variant B (basic training with teacher-directed presentation, two 90 min sessions), variant C (comprehensive training, four sessions), variant D (including additional psychological components, minimum five sessions), or variant E (equivalent to B in outpatient context). At the end of the training the perceived satisfaction with the programme and reported personal benefit were assessed by means of a new inventory that was developed.
The sample comprised N = 320 patients (n = 244 inpatients and n = 76 outpatients) ranging in age from 18 to 80 years (M = 46.3 years). The average total score for educational satisfaction of all participants was 8.0 (maximum score = 10). Choice of topics was judged particularly positive (M = 8.58), followed by the structure of training/setting-conditions (M = 8.0). The perceived personal benefit from the training was evaluated less positively (M = 7.32). When comparing the programme variants, patients’ average satisfaction tends to increase with the extent and intensity of the training offered. Outpatients showed significantly less satisfaction in contrast to inpatients. Inpatients’ satisfaction with the three variants increased with extensiveness and intensity of the training, while the contrast of between-group comparisons (B–C, B–D and C–D) was significant.
Assessment of the patient's view of health care services should complement standardised evaluation methods, especially in multi-intervention rehabilitation programmes.
Rehabilitation-specific diagnostic measures should be developed and validated in order to better assess patients’ satisfaction and training efficacy from the patient's perspective. Further study is recommended on how far individualised training measures might increase subjective benefit.

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

Abstract

Introduction

Section snippets

Study design

Sample

Discussion

Acknowledgements

Patient Educ. Couns.

NHG-Standaard astma bij volwassenen: behandeling (NHG guideline on asthma in adults: treatment)

Huisarts Wet

Comparison of guidelines and self management plans in asthma

Eur. Resp. J.

How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication

Am. J. Resp. Crit. Care Med.

Compliance with inhaled medication and self-treatment guidelines following a self-management programme in adult asthmatics

Eur. Resp. J.

Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education?

Eur. Resp. J.

Impact of education on treatment compliance in patients with asthma

Monaldi Arch Chest Dis.

Voorlichting aan carapatienten. ontwikkeling en evaluatie van richtlijnen voor de huisarts (patient education for COPD patients

Huisarts Wet