Archives of Internal Medicine · 1990 · 279 citations · 20 references
NursingHealth EducationInternal MedicineGeneral Internal MedicineImplementation ScienceSelf-management SupportAsthma ManagementHealth CoachingPatient AdherencePatient Education For Self-managementSelf-care PracticesSelf-managementAdherence In Asthma ManagementAdherence InterventionsAdult Asthma ManagementAsthma Patient CounselingAsthma Self-management EducationAsthma Severity AssessmentOne-to-one InterventionRandomized Controlled Trial Baseline
Adult asthma is common and poorly managed, with many patients failing to adhere to treatment regimens. The authors created a workbook‑based, one‑to‑one counseling program with adherence‑enhancing strategies, then randomized patients to this 1‑year intervention versus usual care pamphlets while controlling for baseline severity. At follow‑up, participants in the self‑management program had markedly higher adherence and better functional status than usual care, although hospital and emergency department visit rates declined similarly in both groups.
The prevalence and impact of adult asthma are substantial, and poor self-management practices, especially failures to adhere to treatment regimens, appear to be a significant problem. Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education resources. A comprehensive program was developed that integrated a workbook with one-to-one counseling and adherence-enhancing strategies. A longitudinal 1-year study compared patients receiving this self-management program with "usual care" patients receiving standard asthma pamphlets. Patients were randomly assigned to conditions. Baseline score and asthma severity were statistically controlled. Self-management patients had substantially better adherence than usual care patients, as well as improved functional status, at follow-up. Hospital and emergency department visits decreased in both groups but did not differ between groups.
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National Trends in the Morbidity and Mortality of Asthma in the US
Richard Evans, Daniel I. Mullally, Ronald W. Wilson et al. · CHEST Journal · 1987 · 515 citations