A glucocorticoid education group meeting: an effective strategy for improving self-management to prevent adrenal crisis

Abstract

Objective: To assess self-management in patients receiving glucocorticoid replacement therapy for primary or secondary adrenal failure before and 6 months after a glucocorticoid education group meeting. Methods: All patients with primary or secondary adrenal insufficiency, treated at the Department of Medicine, Division of Endocrinology, were invited by their endocrinologist to participate in a 3-h glucocorticoid education group meeting, consisting of a lecture about the disease and glucocorticoid doses adjustments in case of stress, followed by an instruction on how to inject hydrocortisone i.m. Finally, all participants could practise the i.m. injection and discuss their experience with (imminent) adrenal crises with other patients and the health care providers. Two weeks before the meeting and 6 months after the meeting, patients were asked to fill out a questionnaire about how they would act in six different conditions (e.g. febrile illness or vomiting). Results: Of the 405 patients who were invited, 246 patients (61%) participated. At baseline the response by the participants on the questionnaire was 100% (nZ246) and at follow-up 74% (nZ183). At follow-up, significantly more participants (P%0.005) gave the correct answers to how to act in different situations (e.g. self-administration of a glucocorticoid injection and phone contact in case of vomiting/diarrhoea without fever). Moreover, the use of self-management tools, such as having a 'medicine passport (travel document with information about disease and medication) (PZ0.007) or SOS medallion (PZ0.0007)', increased. Conclusion: A glucocorticoid education group meeting for patients with adrenal failure seems helpful to improve self-management and proper use of stress-related glucocorticoid dose adjustment.

Adrenal Crisis: Still a Deadly Event in the 21st Century

“…As patients can deteriorate quickly, it is crucial that patients are equipped to administer it at home. However, while many patients may have a hydrocortisone ampoule at home, not all will have practiced the injection before, 40 and a majority of patients rely on emergency medical personnel to administer it during an episode of adrenal crisis. 17 Significant physical or cognitive impairment of patients can occur during illness, which can affect their ability to make the correct decisions or administer medications.…”

“…Nurse educators or patient group education meetings about sick day rules can improve patients' knowledge of their condition, and improve their response to illness. 40 However, in a recent prospective study, 18% of patients still failed to adjust their doses despite having received prior education. 18 Hence, it is important to constantly re-evaluate patients' understanding and to assess their reaction to illness.…”

Structured nursing educational programs improve quality of life outcomes in patients with Cushing’s syndrome

“…A more recent study found that a nursing educational program delivered over a 3-h group meeting (N = 246; 71 % secondary adrenal insufficiency) showed significant improvement (p \ 0.05) at 6 months post intervention in patients' self-management skills to prevent adrenal crisis [5].…”

“…Improved self-management skills for glucocorticoid replacement form a cornerstone in the care of patients with Cushing's syndrome who develop adrenal insufficiency and the above studies emphasize the importance of patient education [4,5]. However, these interventions have a narrow focus, and unlike the Martinez-Momblan et al's study [3], they do not take into consideration the patient's holistic self-management needs and QoL parameters.…”

“…Response rates of 49 % (N = 61) [3] and 61 % (N = 246) [5] were achieved and it would have been useful for these studies to have explored why patients declined participation in the educational program.…”