Self-management education and regular practitioner review for adults with asthma

Abstract

Background A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes. Objectives The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma. Search strategy We searched the Cochrane Airways Group trials register and reference lists of articles. Selection criteria Randomised trials of self-management education in adults over 16 years of age with asthma. Data collection and analysis Two reviewers assessed trial quality and extracted data independently. We contacted study authors for confirmation. Main results We included thirty six trials, which compared self-management education with usual care. Self-management education reduced hospitalisations (relative risk (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82); emergency room visits (RR 0.82, 95% CI 0.73 to 0.94); unscheduled visits to the doctor (RR 0.68, 95% CI 0.56 to 0.81); days off work or school (RR 0.79, 95% CI 0.67 to 0.93); nocturnal asthma (RR 0.67, 95% CI 0.0.56 to 0.79); and quality of life (standard mean difference 0.29,CI 0.11 to 0.47). Measures of lung function were little changed. Authors' conclusions Education in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan improves health outcomes for adults with asthma. Training programmes that enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.

Systematic care for asthma in Australian general practice: a randomised controlled trial

“…Our results overall do not accord with a previous systematic review that found that a model of care incorporating self‐monitoring, regular medical review and a written action plan improved many patient outcomes including the number of hospitalisations, unscheduled visits to doctors, days off from work and study, and bouts of nocturnal asthma 13 …”

Systematic care for asthma in Australian general practice: a randomised controlled trial

“…Our results overall do not accord with a previous systematic review that found that a model of care incorporating self‐monitoring, regular medical review and a written action plan improved many patient outcomes including the number of hospitalisations, unscheduled visits to doctors, days off from work and study, and bouts of nocturnal asthma 13 …”

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

“…Our results support trends found in previous investigations 10,20 and highlight an overall improvement in the quality of care for asthma patients. Therefore, we conclude that since the implementation of the DMP for asthma in Bavaria in 2006, adherence to guidelines, symptom frequency, and pharmacotherapy have improved.…”

Asthma patients with low perceived burden of illness: a challenge for guideline adherence

“…Another critical point is the low amount of patients receiving education and training for self‐management. The relevance of these measures for reducing disability and hospitalization has been shown in many studies [22]. Our results are similar to the survey of Meng et al .…”

Systematic care for asthma in Australian general practice: a randomised controlled trial

“…Our results overall do not accord with a previous systematic review that found that a model of care incorporating self‐monitoring, regular medical review and a written action plan improved many patient outcomes including the number of hospitalisations, unscheduled visits to doctors, days off from work and study, and bouts of nocturnal asthma 13 …”

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

“…Our results support trends found in previous investigations 10,20 and highlight an overall improvement in the quality of care for asthma patients. Therefore, we conclude that since the implementation of the DMP for asthma in Bavaria in 2006, adherence to guidelines, symptom frequency, and pharmacotherapy have improved.…”

Asthma patients with low perceived burden of illness: a challenge for guideline adherence

“…Another critical point is the low amount of patients receiving education and training for self‐management. The relevance of these measures for reducing disability and hospitalization has been shown in many studies [22]. Our results are similar to the survey of Meng et al .…”

Systematic care for asthma in Australian general practice: a randomised controlled trial

“…Our results overall do not accord with a previous systematic review that found that a model of care incorporating self‐monitoring, regular medical review and a written action plan improved many patient outcomes including the number of hospitalisations, unscheduled visits to doctors, days off from work and study, and bouts of nocturnal asthma 13 …”

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

“…Our results support trends found in previous investigations 10,20 and highlight an overall improvement in the quality of care for asthma patients. Therefore, we conclude that since the implementation of the DMP for asthma in Bavaria in 2006, adherence to guidelines, symptom frequency, and pharmacotherapy have improved.…”

Asthma patients with low perceived burden of illness: a challenge for guideline adherence

“…Another critical point is the low amount of patients receiving education and training for self‐management. The relevance of these measures for reducing disability and hospitalization has been shown in many studies [22]. Our results are similar to the survey of Meng et al .…”