Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?

Abstract

Objectives: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Design: Randomised equivalence trial. Setting: 39 general practices in West London and North West England. Participants: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education.Intervention: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Main outcome measures: Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids. Results: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference 28.1% to 6.6%; 95% CI for difference 29.5% to 8.0%). The 90% CI contained the predetermined equivalence region (25% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. Trial registration number: NCT00129987Worldwide, 300 million people have asthma; 5.2 million have the condition in the UK.

Benefits of an asthma education program provided at primary care sites on asthma outcomes

“…In order to improve this situation, training programs for asthma educators and education networks have been developed in the last decades [7,8]. In the province of Quebec, the Quebec Asthma and Chronic Obstructive Pulmonary Disease (COPD) Network (QACN) has helped develop more than 100 asthma and COPD Education Centers and regularly trains the educators offering free educational interventions in these institutions [7,9].…”

Repercussão de uma intervenção educativa com agentes comunitários de saúde nas condições ambientais de domicílios de crianças asmáticas

“…The results reported, in terms of unscheduled medical visits, courses of corticosteroids, and patient satisfaction, were similar between the two groups. (16) However, in the present study, we did not analyze this aspect (the type of instructor). Instead, we analyzed changes in environmental control, changes that in fact occurred, indicating that most of the CHAs understood the content of the educational intervention and provided information to the caregivers, which resulted in changes in the aeroallergen levels within the home environments.…”

“…Those findings differ from the results reported in the aforementioned study conducted in the United Kingdom. (16) Therefore, we should be education was delivered by nurses and one in which this education was delivered by lay people trained for the task). Patients in both groups were provided with individualized action plans and received telephone follow-up.…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…Trained lay health educators can deliver discrete areas of respiratory care such as asthma self-management education, with comparable outcomes to those achieved by practice nurses based in primary care 241 (Evidence B). …”