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19 Effectiveness of a psychological intervention program as a complementary treatment of adult asthmatic patients
S8
Abstracts
J ALLERGY CLIN IMMUNOL JANUARY 2000
18 Impact
of Patient Education on Knowledge and Skills for Inhaled Medications Cynrhia C. Bartz. Elizabeth A. Levvas. Sandra C. Christiansen Scripps Clinic Patients with asthma often have suboptimal skills and inadequate information for the effective use of inhaled medications. Our study was designed to test the impact of patient education on medication delivery skills and knowledge of drug properties. Subjects between ages of 10 and 65 referred for allergy/asthma consultation were enrolled at Scripps Clinic. A questionnaire was developed to assess patient understanding of the purpose, risks. side effects, appropriate dose and interval for use of inhaled asthma medications. An inhaler checklist to score appropriate technique was utilized for determination of patient skill level. Patients received education from trained allergy nurses incorporating inhaler demonstrator devices and supplemental handouts following the specialty consultation. Testing was performed at baseline and one month following asthma education. Twenty-three baseline questionnaires and 21 checklists were completed prior to education. At baseline, the mean number of errors per subject was 2.lkO.4 (SEM) for the questionnaire and 2.6iO.3 (SEM) for the inhaler technique. Fifteen individuals completed the 1 month post education questionnaire and inhaler checklist. At follow-up, improved scores were demonstrated in each area with a mean of 0.621.2 (SEM) errors on the questionnaire and l&l .3 (SEM) errors on the checklist. Nonparametric Wilcoxon Signed Rank Test analysis confirmed a statistically significant difference for the questionnaire (p value = .Ol 1) and a trend of improvement for inhaler technique (p value =.208) one month post education. This study supports the effectiveness of asthma education delivered in the course of specialty care as a tool for optimizing patient knowledge and skills.
recruited from an allergy consulting room of a public health center in Madrid (Spain). Daily pulmonary function. symptoms, disease morbidity (emergency-room attendance due to asthma, physician’s attendance due to asthma, work absenteeism, etc.). anxiety level and quality of life have been pre- and post-intervention assessed as effectiveness outcomes. Results show a significant improvement after the treatment of many of the outcomes such as symptoms, anxiety level and quality of life. In addition, there are not significant effectiveness differences between modules. This result suggests the suitability of the combination of both types of therapies as a complement of the medical treatment of bronchial asthma.
Asthma
19
Effectiveness plementary
of a Psychological Treatment of Adult
Intervention Asthmatic
Program as a ComPatients AP Martblez-
Donare*. V Rubio*, J Contreras)‘. P De Diego?, P Serrarlof, C L&e?Serranoi *Aut6noma University of Madrid ‘Center of Health
Specialities Jose Marva (Spanish Health Institute) SUniversity Hospital La Paz (Spanish Health Institute) Bronchial asthma is a chronic respiratory disease which might significantly reduce the quality of life of patients if it is not correctly controlled. It is currently assumed that bronchial asthma is a multi-caused illness in which several variables might play a role. Psychological variables, such as emotions, stress and anxiety could act as a triggers (e.g. an intense emotion), as a mediator of the attacks (e.g. increasing the hyperventilation) or as a consequence of the disease which may negatively affect daily life activities (e.g. reducing self-esteem). Several studies have shown the relationship between these variables and the frequency of asthma attacks, the amount of pharmacological treatment required or the number of hospitalizations due to asthma. Moreover, research has been carried out to check the effectiveness of several psychological techniques as a complementary treatment of asthma. The techniques more frequently used have been muscle relaxation training, conditioning and learning to enhance asthma self management, and cognitive therapy. The results suggested the suitability of these ones as complementary treatment. In this way, a psychological intervention program has been developed consisting of two different modules: a self-management training and a relaxation plus cognitive therapy module. The present work attempts to evaluate the effectiveness of the whole program and each of its components. 70 adult medically prestabilized asthmatics were voluntarily
20
The Children’s Asthma Education active, Individualized Approach
Centre: A Small Group, Interto Asthma Education CA Gil-
lespie*. MP Piwniuk*. JE McColnl *, NJ Thomas*. AB Becker*i. FER Simons*i. WTA Warson*? *The
SE Filuk-Emu*.
Children’s
Asthma Education Centre tuniversity of Manitoba Good self-management is a requirement for asthma control. Effective education is necessary for asthma self-management. It is difficult to deliver comprehensive asthma education in the office setting. An efficient alternative may be referral to group education, with group sharing and support being added benefits. At the Children’s Hospital, Winnipeg. we developed a program for small group asthma education with core content that is interactive and allows for individualization. The program is based on small group learning principles with four to seven families involved in four classes at weekly intervals. Assignment to the groups is based on age of the child. For preschoolers, the parents are the primary focus for education; for school-aged children, both parent and child are the focus: and for adolescents, the “teen” is the focus for education. The four primary topics reviewed are “What is Asthma?’ “Asthma Triggers and Avoidance”, ‘Asthma Medications” and “Asthma Self-Management”. Each session was developed with learning objectives and age-appropriate activities for the participants. Interaction among families is encouraged. Problem solving is incorporated by working through issues and concerns raised by each family. All participants are instructed on the measures of environmental control, appropriate use of medication delivery systems, peak expiratory flow monitoring, asthma diaries and asthma action plans. One unique component of our program is personalized letters at 2. 4,6 and 12 months to reinforce key messages following completion of the education sessions. These letters focus on asthma action plans, asthma triggers, use of medications based on the action plan and promotion of asthma self-management with an emphasis on continued learning about asthma. To date we have 353 families enrolled in the program with 194 patients completed. A control group with minimal asthma education is an integral part of the evaluation process to assess the impact of asthma education on health outcomes. The Children’s Asthma Education Centre provides a program that is pragmatic in its approach to asthma education and self-management. with a core content that builds upon peer group experiences and support.
Abstracts
J ALLERGY CLIN IMMUNOL JANUARY 2000
18 Impact
of Patient Education on Knowledge and Skills for Inhaled Medications Cynrhia C. Bartz. Elizabeth A. Levvas. Sandra C. Christiansen Scripps Clinic Patients with asthma often have suboptimal skills and inadequate information for the effective use of inhaled medications. Our study was designed to test the impact of patient education on medication delivery skills and knowledge of drug properties. Subjects between ages of 10 and 65 referred for allergy/asthma consultation were enrolled at Scripps Clinic. A questionnaire was developed to assess patient understanding of the purpose, risks. side effects, appropriate dose and interval for use of inhaled asthma medications. An inhaler checklist to score appropriate technique was utilized for determination of patient skill level. Patients received education from trained allergy nurses incorporating inhaler demonstrator devices and supplemental handouts following the specialty consultation. Testing was performed at baseline and one month following asthma education. Twenty-three baseline questionnaires and 21 checklists were completed prior to education. At baseline, the mean number of errors per subject was 2.lkO.4 (SEM) for the questionnaire and 2.6iO.3 (SEM) for the inhaler technique. Fifteen individuals completed the 1 month post education questionnaire and inhaler checklist. At follow-up, improved scores were demonstrated in each area with a mean of 0.621.2 (SEM) errors on the questionnaire and l&l .3 (SEM) errors on the checklist. Nonparametric Wilcoxon Signed Rank Test analysis confirmed a statistically significant difference for the questionnaire (p value = .Ol 1) and a trend of improvement for inhaler technique (p value =.208) one month post education. This study supports the effectiveness of asthma education delivered in the course of specialty care as a tool for optimizing patient knowledge and skills.
recruited from an allergy consulting room of a public health center in Madrid (Spain). Daily pulmonary function. symptoms, disease morbidity (emergency-room attendance due to asthma, physician’s attendance due to asthma, work absenteeism, etc.). anxiety level and quality of life have been pre- and post-intervention assessed as effectiveness outcomes. Results show a significant improvement after the treatment of many of the outcomes such as symptoms, anxiety level and quality of life. In addition, there are not significant effectiveness differences between modules. This result suggests the suitability of the combination of both types of therapies as a complement of the medical treatment of bronchial asthma.
Asthma
19
Effectiveness plementary
of a Psychological Treatment of Adult
Intervention Asthmatic
Program as a ComPatients AP Martblez-
Donare*. V Rubio*, J Contreras)‘. P De Diego?, P Serrarlof, C L&e?Serranoi *Aut6noma University of Madrid ‘Center of Health
Specialities Jose Marva (Spanish Health Institute) SUniversity Hospital La Paz (Spanish Health Institute) Bronchial asthma is a chronic respiratory disease which might significantly reduce the quality of life of patients if it is not correctly controlled. It is currently assumed that bronchial asthma is a multi-caused illness in which several variables might play a role. Psychological variables, such as emotions, stress and anxiety could act as a triggers (e.g. an intense emotion), as a mediator of the attacks (e.g. increasing the hyperventilation) or as a consequence of the disease which may negatively affect daily life activities (e.g. reducing self-esteem). Several studies have shown the relationship between these variables and the frequency of asthma attacks, the amount of pharmacological treatment required or the number of hospitalizations due to asthma. Moreover, research has been carried out to check the effectiveness of several psychological techniques as a complementary treatment of asthma. The techniques more frequently used have been muscle relaxation training, conditioning and learning to enhance asthma self management, and cognitive therapy. The results suggested the suitability of these ones as complementary treatment. In this way, a psychological intervention program has been developed consisting of two different modules: a self-management training and a relaxation plus cognitive therapy module. The present work attempts to evaluate the effectiveness of the whole program and each of its components. 70 adult medically prestabilized asthmatics were voluntarily
20
The Children’s Asthma Education active, Individualized Approach
Centre: A Small Group, Interto Asthma Education CA Gil-
lespie*. MP Piwniuk*. JE McColnl *, NJ Thomas*. AB Becker*i. FER Simons*i. WTA Warson*? *The
SE Filuk-Emu*.
Children’s
Asthma Education Centre tuniversity of Manitoba Good self-management is a requirement for asthma control. Effective education is necessary for asthma self-management. It is difficult to deliver comprehensive asthma education in the office setting. An efficient alternative may be referral to group education, with group sharing and support being added benefits. At the Children’s Hospital, Winnipeg. we developed a program for small group asthma education with core content that is interactive and allows for individualization. The program is based on small group learning principles with four to seven families involved in four classes at weekly intervals. Assignment to the groups is based on age of the child. For preschoolers, the parents are the primary focus for education; for school-aged children, both parent and child are the focus: and for adolescents, the “teen” is the focus for education. The four primary topics reviewed are “What is Asthma?’ “Asthma Triggers and Avoidance”, ‘Asthma Medications” and “Asthma Self-Management”. Each session was developed with learning objectives and age-appropriate activities for the participants. Interaction among families is encouraged. Problem solving is incorporated by working through issues and concerns raised by each family. All participants are instructed on the measures of environmental control, appropriate use of medication delivery systems, peak expiratory flow monitoring, asthma diaries and asthma action plans. One unique component of our program is personalized letters at 2. 4,6 and 12 months to reinforce key messages following completion of the education sessions. These letters focus on asthma action plans, asthma triggers, use of medications based on the action plan and promotion of asthma self-management with an emphasis on continued learning about asthma. To date we have 353 families enrolled in the program with 194 patients completed. A control group with minimal asthma education is an integral part of the evaluation process to assess the impact of asthma education on health outcomes. The Children’s Asthma Education Centre provides a program that is pragmatic in its approach to asthma education and self-management. with a core content that builds upon peer group experiences and support.