| Reference | Study Purpose | Target population | Study Design | Type of intervention | Results |
|---|---|---|---|---|---|
| Barbanel et al.137 | To evaluate whether a community pharmacist with basic asthma training could improve asthma control by providing self-management advice. | 23 adults aged 18–65 years with asthma living in inner city East London. Nint=12, Ncon=11. | RCT | Intervention patients received a 45–60 minute individual session from the pharmacist on asthma pathophysiology, recognition and avoidance of triggers, inhaler technique, self-management skills including symptom and PF monitoring, actions in response to worsening symptoms, accessing emergency care, and smoking cessation, if relevant. They received written self-management plans and weekly phone calls for the next 3 months to review plans and answer questions. | 3 months after the intervention, the symptom score increased in the control group and decreased in the intervention group (p<0.001).137 |
| Cordina et al.159 | To examine the effects of a community pharmacy-based education and monitoring program for patients with asthma on a range of patient-specific asthma management outcomes. | 152 patients over the age of 14 who received their asthma prescriptions at private pharmacies in Malta. | CBA* | A comprehensive asthma education and monitoring program was instituted in private pharmacies in Malta for 12 months. The intervention pharmacists reviewed patients asthma symptoms, PF records, medication use, and when necessary suggested changes in treatment to the patient's physician. | There was no significant difference between treatment and control groups in terms of PF measurement, self-reported inhaler use, days lost from work or school, or health related QOL. There were fewer self-reported hospitalizations for asthma among intervention patients (0/86) than among control patients (8/66) (p<0.002) but no other differences in health services utilization. The intervention patients were less likely to report nighttime wheezing and more likely to improve their inhaler technique than control patients. 159 |
| Garrett et al.152, 153 | To determine the efficacy of establishing a community asthma education center. | 747 patients aged 2–55 years who had received asthma care in the ED in South Auckland. | CBA | 2 nurse specialists and a group of respiratory physicians established a community education center run by a nurse and 3 community health workers. The purpose of the education program provided was to educate patients in basic pathophysiology, define and teach trigger avoidance, medications use, inhaler technique and self-management skills (emphasis on PF recordings and symptom diaries), and teach how best to access medical care in response to worsening symptoms. | At nine months, the intervention group were more likely to have preventive medications, PF meters and better PF meter technique, more self-management plans, better knowledge of appropriate action to take when confronted with worsening asthma, less nocturnal awakening, and better self-reported asthma control than the control group. There was no difference between intervention and study patients in medication compliance, hospital admissions, days lost from school or work, ED visits, QOL, or smoking rates (33% for control group and 34% for the intervention group).152 |
| Heard et al.155 | To test whether asthma clinics (intervention) were more effective in reducing morbidity from asthma than standard medical treatment (control). | 195 asthma patients aged 5–64 years in Australia. | RCT | Each participating practice operated one 3-hour asthma clinic (run by trained nurses) once a week, which were. Clinic sessions involved education in asthma management strategies, written asthma management plans, spirometry and PF instruction, and an asthma diary card. Sessions ended with a consultation with the general practitioner. Patients were asked to attend 3 sessions within the 6 month study interval. | At the end of the study, patients in the intervention group were more likely to own a PF meter and to be smokers than those in the control group. Intervention patients were less likely to wake at least weekly at night due to asthma than control patients. There were no differences in reported time lost from work or school, having an action plan, use of medications, or health services utilization between intervention and control patients. Baseline smoking rates of 9% in the control group and 12% in the intervention group did not change.155 |
| Johnson et al.180 | To evaluate the effectiveness of a comprehensive asthma disease management program. | Patients with asthma covered by Anthem Blue Cross and Blue Shield insurance in the U.S. Nint=196, Ncon=196. | CBA | The intervention lasted 12 months. Intervention subjects received teaching that emphasized self-management behaviors such as avoidance of triggers, correct medication use, recognizing symptoms, seeking medical advice, smoking cessation, and adherence to treatment plans. The program is supported by computer generated communications to providers and case managers regarding whether the patient has an action plan, received flu vaccination, has a rescue inhaler, and use of daily controller medications. | 12 months after the intervention, the intervention group had fewer ED visits (118 vs. 305, p<0.0001) and hospitalizations (39 vs. 114, p<0.0001). There were no differences in use of asthma medications or preventative vaccinations. 180 |
| Jones and Mullee244 | To compare the outcome of asthma care in two similar practices when on practice provided proactive, nurse-run care for asthma and the other continued with a traditional (reactive) approach to the disease. | 141 asthma patients aged 5–65 years receiving care in two general practices in the Southampton area of the U.K. | CBA | The intervention practice established a nurse-led asthma clinic in which specialist nurses identified patients with asthma, developed a therapeutic plan for these patients, and developed a “call” system to contact patients with asthma for assessment and follow up. | There were no significant difference between the intervention and control patients in terms of PF, symptoms, health services utilization, or medication use.244 |
| Pilotto et al.158 | To assess the ability of nurse-run asthma clinics based in general practice compared with usual medical care to produce at least a moderate improvement in the QOL in adults with asthma. | 153 patients with asthma over the age of 18 from general practices in Australia. Ncon=82, Nint=71. | RCT | Two respiratory nurses conducted asthma clinics where baseline data was collected, a review of and instruction about inhaler technique was provided, and a packet of information was distributed to each patient. Follow up visits were scheduled at 2 weeks, 3, 6, and 9 months to review inhaler technique and answer questions. Control patients received usual care by their general practitioner. | After 9 months, no significant differences between the intervention and control groups in QOL scores, FEV1, ED visits, clinic visits or hospitalizations. However, significantly less people in the intervention group compared to the control missed one or more days of work (p=0.004).158 |
| Rasmussen et al. 190 | To assess the outcomes associated with an Internet-based asthma management tool. | 253 adults with asthma aged 18–45 years living in Denmark. Ncont-GP=80, Ncont-sp=88, Nint=85. | RCT | There were three groups: an internet management group, a group receiving treatment from an asthma specialist, and a group receiving care from a general practitioner (GP). The Internet-based management tool was comprised of an electronic asthma diary, an action plan for patients, and a decision support system for physicians. Patients were given PF meters, and the Internet tool's action plan comprised a 3-color warning system with a written treatment plan. Patients were encouraged to fill out the diary daily and follow instructions given by the computer or physician. Physicians used the decision support system to follow up with patients on therapeutic changes. | After 6 months, the Internet group had significantly fewer asthma symptoms (p=0.002 compared to specialists; p<0.001 compared to GPs), higher QOL (p=0.03 compared to specialists, p=0.04 compared to GPs), and better FEV1 (p=0.002 compared to specialists, p<0.001 compared to GPs). The Internet group had significantly more acute, unscheduled visits compared to the two control groups (p=0.05). No significant differences among the groups were found in ED visits, hospitalizations, or medication compliance.190 |
| Swanson et al.243 | To evaluate the effects of a health board program on asthma care in general practice in terms of patients' service and use of self-management. | 400 patients aged 2–50 years with asthma receiving care in registered general practices in the U.K. between 1992 and 1994. | CBA | The Scottish health board developed an asthma program which included protocols for asthma treatment, assessment and follow up record cards for use in asthma clinics, and PF diaries. | Chart reviews of patients receiving care in practices adhering to the health board program compared to those of patients receiving care in other general practices. There was no significant difference between patients in terms of the number of general practitioner visits or hospitalizations, days lost from work or school, nighttime awakening from asthma, smoking rates (20% for intervention group and 25% for the control group); however, patients in the intervention group were more likely to make asthma clinic visits than control group patients (p<0.001) and more likely to have PF diaries and asthma self-management plans.243 |
| Verver et al.125 | To evaluate whether inhaler technique and respiratory symptoms of patients with asthma can be improved after instruction by a practice assistant. | 6 physicians assistants were trained in the appropriate use of powder inhalers and provided patient education to 48 Dutch asthma patients aged 15–85 years. | RCT | Patients received two training sessions (2 weeks apart) on the correct technique for use of dry powder inhalers (and the correct order in which to use multiple inhalers). | At baseline only 6% of all patients used the dry powder inhalers correctly. Most mistakes were made with the “breathe out” before inhaling and with the “hold your breath for 5 seconds” after inhaling instructions. There was no correlation between the number of inhaler errors and symptoms. The patients in the instruction group significantly reduced the number of inhaler use errors (p=0.01). There was no difference in reported asthma symptoms between the two groups.125 |
| Weng194 | To evaluate the effects of a government sponsored QI intervention with patient and provider education and case management services for patients with asthma. | 1,067 patients with asthma enrolled in the program sponsored by the Taiwanese government. 4,340 patients with asthma who did not enroll in the program served as matched controls. | CBA | Providers received a 6-hour asthma curriculum that included conducting pulmonary function testing, use of medications and PF monitoring, environmental controls, and asthma pathophysiology. They were given copies of asthma clinical practice guidelines. Patients received individualized, personally tailored asthma education on recognizing triggers and symptoms, medication use, PF use, and self-management of exacerbations. Case managers (nurses or physician assistants) provided communication between patients, primary care physicians and specialists, and scheduled quarterly follow up. | 1 year after enrollment, the intervention group had longer hospital stays (by 40%, p=0.045) but no difference from control patients in the number ED visits or number of hospitalizations. However, among patients newly diagnosed with asthma during the study interval, there was a decrease in ED visits (by 61%) in the intervention group compared to the controls.194 |
Note: *CBA=controlled before-after trials; ED=emergency department; PF=peak flow; QOL=quality of life.
From: 3, Results
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