| Sumario: | Question: Is education in self management plus regular review by doctors or nurse practitioners effective in improving health outcomes for adults with asthma? Data sources: Studies were identified using Medline, Embase/Excerpta Medica, and CINAHL with the terms asthma or wheeze and education or self management. Bibliographies of studies were scanned and 16 respiratory journals and meeting abstracts from 3 specialty societies were handsearched. Study selection: Randomised controlled trials (RCTs) were selected if the patients were predominantly adults with confirmed asthma, the intervention included education related to asthma and its management, and the outcomes included any of hospital admissions, emergency department visits, unscheduled doctor visits, days lost from work or school, forced expiratory volume at 1 second, peak expiratory flow, use of rescue beta agonists, course of oral corticosteroids, symptom scores, quality of life scores, or economic outcomes. Data extraction: Data were extracted on study quality, patient and disease characteristics, educational interventions, health outcomes, intermediate outcomes (knowledge and skills), type of control, and duration of intervention. Interventions were divided into categories of optimal self management (a written action plan for self management of medications for exacerbations, self monitoring, and regular review); self monitoring and regular review without a written action plan; self monitoring only; and regular review only. Main results: 22 RCTs met the inclusion criteria (25 articles). 27 self management programmes were studied that included >/= 1 of asthma education (n = 25 interventions), self monitoring (n = 23), regular review (n = 16), and a written plan (n = 12). 7 categories of settings and 9 outcomes were included. Self management led to reductions in the proportion of patients who were admitted to hospital, had unscheduled doctor visits, had days off work or school, and had nocturnal asthma (table). Optimal self management generally showed greater reductions and was also associated with improved lung function. A written action plan was associated with fewer hospital admissions. 5 studies compared optimal self management with doctor managed care and no differences were found in outcomes. Conclusions: Patients with asthma who are given self care management education have a lower incidence of hospital admissions, unscheduled doctor visits, days off work, and noctural asthma. Reductions are greater when self management education includes a written care plan. [Original article accession number: 1999023083]
|
|---|