Effectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trial
Introduction
A substantial discrepancy between provided care and guidelines for adequate treatment has been demonstrated in patients with (mild to moderate) asthma or chronic obstructive pulmonary disease (COPD) in primary care [1], [2]. Previous research reported undertreatment, insufficient patient knowledge (about disease, prescribed medication, and triggers provoking exacerbation), poor compliance, and an incorrect inhalation technique [1], [3], [4], [5]. Health education by the general practitioner (GP) usually occurs in the early phase of the disease, or when patients present themselves with an exacerbation [2], [6]. Without sufficient follow-up, information may not be easily understood or retained. The undertreatment of patients with asthma and COPD has also been attributed to the relative complex treatment schedule and the high workload of Dutch GPs, as a result of which disease-specific education may often be neglected [7], [8].
Recent reviews have shown that programmes containing information only, given through a video, booklet or computer, do not improve health outcomes [9]. Extensive self-management programmes overall did lead to an improvement of most health outcomes [10], [11]. However, almost all reviewed programmes were carried out among more severely ill patients, whereas the majority of patients have mild to moderate asthma or COPD and are treated in primary care [10], [11]. More seriously diseased patients are seen by a specialist on a regular basis and are probably more motivated, creating better opportunities to integrate self-management programmes into daily care [12], [13]. Nevertheless, patients in primary care do need extra care, and might benefit from a less extensive programme.
The GP-assistant in The Netherlands gives administrative support to the GP and assists in minor medical interventions. In order to improve care, create easily accessible care for patients, and unburden the GPs, tasks can be delegated to well trained GP-assistants [14]. We developed a brief education programme provided by a GP-assistant, that addresses individual knowledge and skills regarding the disease, medication, compliance, inhalation technique, smoking behaviour and management of disease specific problems which in turn may also positively influence coping and self-efficacy. This paper reports on a randomised controlled trial (RCT) on the effectiveness of this education programme on disease symptoms and HRQoL, by comparing it with usual-care.
Section snippets
Patient selection
Fourteen GPs from 12 general practices in The Netherlands selected patients with asthma or COPD from their practice records using the following inclusion criteria: a clinical diagnosis of asthma, COPD or mixed disease (asthma with persisting airway obstruction) [15], age 16–75 years, treated by the GP, and the absence of other specific pulmonary or terminal diseases. All patients were invited for a baseline assessment between January 1998 and January 1999. Based on this assessment, only
Recruitment
Of the 663 patients selected by the GPs and invited for baseline assessment, 124 could not be contacted, while 63 refused to participate (Fig. 1). Among the non-responders, there were significantly more males and younger patients. Of the 476 patients assessed, 276 (58%) patients met all inclusion criteria and were randomly allocated to either the intervention (n=139) or usual-care group (n=137).
After one year 17% in the intervention group versus 31% in the usual-care group were lost to
Discussion and conclusion
The education programme developed for primary care patients with asthma or COPD resulted in only small and non-significant changes on disease symptoms or HRQoL. Inhalation technique, which is required for good disease control, was significantly better in the intervention than in the usual-care group.
Acknowledgements
The authors thank the patients and general practitioners for their co-operation and the pulmonary function assistants in the WestFries Gasthuis for conducting the measurements. We also thank the general practice assistants, Paula van den Broek and Sylvia Ruiter, for their enormous effort and excellent work in conducting the education programme.
References (31)
- et al.
Is asthma self-management cost-effective?
Patient Educ. Couns
(1997) - et al.
Effectiveness of a minimal contact smoking cessation program for Dutch general practitioners: a randomized controlled trial
Prev. Med
(2001) - et al.
Determinants of different dimensions of disease severity in asthma and COPD: pulmonary function and health-related quality of life
Chest
(2001) - et al.
The development of the ‘Quality-of-life for Respiratory Illness Questionnaire (QOL-RIQ)’: a disease-specific quality-of-life questionnaire for patients with mild to moderate chronic non-specific lung disease
Respir. Med
(1997) - et al.
The COPD Self-Efficacy Scale
Chest
(1991) - et al.
Smoking cessation: which aids are worthwhile?
Neth. J. Med
(2000) - et al.
Impact of COPD in North America and Europe in 2000: subjects’ perspective of Confronting COPD International Survey
Eur. Respir J
(2002) Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education?
Eur. Respir J
(1995)- et al.
Compliance with pulmonary medication in general practice
Eur. Respir J
(1993) - et al.
Determinants of an incorrect inhalation technique in patients with asthma or COPD
Scand J. Prim. Health Care
(2001)
A comparison of six different ways of expressing the bronchodilating response in asthma and COPD reproducibility and dependence of prebronchodilator FEV1
Eur. Respir J
Education of adult patients at an “asthma school”: effects on quality of life
Eur. Respir J
Management of asthma and COPD patients: feasibility of the application of guidelines in general practice
Int. J. Qual. Health Care
Self-treatment of asthma: possibilities and perspectives from the practitioner’s point of view
Fam. Pract
Cited by (66)
Smoking cessation treatment for smokers with COPD: The importance of therapeutic education
2023, Revue des Maladies RespiratoiresOne additional educational session in inhaler use to patients with COPD in primary health care – A controlled clinical trial
2022, Patient Education and CounselingPatient education during hospital admission due to exacerbation of chronic obstructive pulmonary disease: Effects on quality of life—Controlled and randomized experimental study
2019, Patient Education and CounselingCitation Excerpt :The results obtained suggest that the patient education program was effective at improving patients’ quality of life, given that those in the IG reduced total SGRQ scores significantly compared to the CG, in absolute and relative terms, on average by -6.83 points and a mean of -10.69 points. Although several studies have shown the benefits of implementing education programs on the quality of life of patients with COPD [41,44,53,45–52], some of them obtained a reduction of -5.0 in the IG [54] (lower than the present study), and others did not find significant improvements after the implementation of the education program in COPD patients [32–35,55–58]. Furthermore, it is important to remember that studies aimed at demonstrating the benefits of these types of programs included exclusively “stable” COPD patients; in our case, patients had an exacerbated condition.
Evaluation of a structured pharmacist-led inhalation technique assessment service for patients with asthma and COPD in Norwegian pharmacies
2018, Patient Education and Counseling