The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.
Chronic disease poses increasing threat to individual and community health. The day-to-day manager of disease is the patient who undertakes actions with the guidance of a clinician. The ability of the patient to control the illness through an effective therapeutic plan is significantly influenced by social and behavioral factors. This article presents a model of patient management of chronic disease that accounts for intrapersonal and extemal influences on management and emphasizes the central role of self-regulatory processes in disease control. Asthma serves as a case for exploration of the model. Findings from a 5-year study of 637 children with asthma and their care-taking parents supported that the self-regulation elements of the model were reasonably stable over time and baseline values were predictive of important disease management outcomes.
This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance.Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1±12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines.Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine.It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care. Annual expenditure by individuals, professional societies, and corporations on professional education are considerable as this form of learning is thought to be a major way in which physicians keep abreast of changes in clinical practice. Nonetheless, little information evaluated by randomized controlled study designs exists in the literature about the impact of education for practicing physicians on the health status of their patients. While studies of continuing medical education are rare [1±3], fewer still are available to assess the persistence or decline of effects over the longer term. Developing potent interventions for clinicians, that change their practices and result in desirable patient outcomes, is important for ultimately improving healthcare and reducing costs.There are at least three reasons for why providing effective continuing education is salient in asthma control. Firstly, a chronic disease like asthma requires an ongoing partnership between clinician and patient and the nature of that relationship has only recently received attention in research [4]. Not all physicians are aware of the elements of partnership (for exam...
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