Trial of a “credit card” asthma self-management plan in a high-risk group of patients with asthma,☆☆,,★★

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Abstract

BACKGROUND: The “credit card” asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma, which are based on the self-assessment of peak expiratory flow rate recordings and symptoms. OBJECTIVE: The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients. METHODS: In this “before-and-after” trial, patients discharged from the emergency department of Wellington Hospital, after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced. Questionnaires were used to compare markers of asthma morbidity, requirement for emergency medical care, and medication use during the 6-month period before and after intervention with the credit card plan. RESULTS: Of the 30 patients with asthma who attended the first outpatient clinic, 26 (17 women and 9 men) completed the program. In these 26 participants, there was a reduction in both morbidity and requirement for acute medical services: specifically, the proportion waking with asthma more than once a week decreased from 65% to 23% (p = 0.005) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58% to 15% (p = 0.004). The patients attending the clinics commented favorably on the plan, in particular on its usefulness as an educational tool for monitoring and treating their asthma. CONCLUSIONS: Although the interpretation of this study is limited by the lack of a randomized control group, the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma. (J ALLERGY CLIN IMMUNOL 1996;97:1085-92.)

Section snippets

Participant selection

From February to October 1991 casualty officers at Wellington Hospital invited adult patients with asthma who were treated for severe asthma in the emergency department and discharged, to attend a free “specialist” hospital outpatient clinic the following week. Patients who attended this initial outpatient clinic were enrolled in the trial if they lived in the Wellington region, had no uncontrolled concomitant medical problems, and were not being seen by a specialist chest physician. Patients

Attendance

During the 8-month recruitment period, 223 adult patients with severe asthma were treated and discharged from the emergency department of Wellington Hospital. Thirty-nine percent (86) of this target population accepted an invitation to attend the asthma clinic. Of these, 38 (44%) eventually attended the initial appointment, and 30 (35%) were considered eligible and were enrolled in the trial. Four subjects did not complete the trial: one withdrew because she had a recent diagnosis of myalgic

DISCUSSION

In this study we have found that the introduction of the credit card asthma self-management plan through a system of hospital-based specialist clinics is an effective method for improving asthma care in a high-risk group of emergency department patients. This high-risk group is characterized by many problems in long-term management, which are not met by the traditional health care system. Despite these difficulties, this program led to a decrease in asthma morbidity, as reflected in a 65%

Acknowledgements

We thank the participants in the program, Dr. Heather Leslie and the staff of the Wellington Hospital Emergency Department, and Sister O’Leary and the staff at Wellington Hospital Main Outpatient Clinics. We also thank Christine Culling and Bridget Robson for help in conducting interviews, Gordon Purdie for statistical advice, and Simon Lewis for graphical assistance.

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    From the Department of Medicine, Wellington School of Medicine.

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    Supported by the Health Research Council of New Zealand. The Wellington Asthma Research Group is funded by a Programme Grant from the Health Research Council of New Zealand, Neil Pearce and Julian Crane are funded by Senior Fellowships of the Health Research Council of New Zealand, and Wendyl D’Souza was funded by a Research Fellowship from the Asthma Foundation of New Zealand and is now funded by a Research Fellowship from the Health Research Council of New Zealand.

    Reprint requests: Richard Beasley, FRACP, DM, Department of Medicine, Wellington School of Medicine, PO Box 7343, Wellington South, Wellington, New Zealand.

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