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Asthma at the interface: bridging the gap between general practice and a district general hospital
I Charlton1, A G Antoniou, J Atkinson
1Department of Paediatrics, University of Southampton.
Insights
A nurse-led asthma clinic improved patient self-management, reducing activity restrictions and acute asthma exacerbations. While readmissions increased, targeted interventions showed promise for better asthma control.
Area of Science:
- Pediatric Pulmonology
- Clinical Nursing
- Health Services Research
Background:
- Asthma management in children often requires effective patient education and self-management strategies.
- Hospital-based outpatient departments and inpatient services manage pediatric asthma cases.
- Developing structured self-management plans is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-supervised asthma clinic utilizing patient education and self-management plans.
- To compare outcomes in children receiving the intervention versus a control group.
Main Methods:
- A randomized controlled study involving 91 children (aged 3-14) with asthma.
- Intervention group received patient education and a self-management plan; control group received standard care.
- Data collected on activity restriction, peak flow, treatment response, school absences, GP visits, and readmissions over a median of 283 days.
Main Results:
- The intervention group experienced significantly less activity restriction and fewer episodes of severely low peak flow.
- Patients in the intervention group were more likely to respond correctly to asthma exacerbations (71% vs. 47%).
- The intervention group had fewer school absences and general practitioner home visits, but a higher readmission rate.
Conclusions:
- Nurse-led patient education and self-management plans can improve asthma control in children, reducing exacerbations and activity limitations.
- Specific self-management strategies, like adjusting inhaled steroid dosage based on peak flow, showed better results.
- Further optimization of follow-up and self-management plan structure may enhance outcomes in pediatric asthma clinics.
Abstract:
A clinic supervised by a nurse, using principles originally developed in general practice, was established in the paediatric department of a district general hospital. A randomised controlled study was conducted comparing children admitted with asthma or attending outpatients who were given a patient education programme and self management plan (intervention group) with a control group. The study comprised 91 patients aged 3-14 years admitted for asthma or attending a hospital outpatient department from November 1989 to November 1990. Seventy seven patients completed the study and kept diaries for a median of 283 days. Patients in the intervention group had significantly less restriction of activity (95% confidence interval (CI) -0.27 to -0.01) and fewer episodes of peak flow below 30% of best (95% CI 0.03 to 1.17). Patients in the intervention group were more likely to make the correct response to an acute exacerbation of their asthma than the control group (71% v 47%, 95% CI 9.51 to 39.1). The intervention group had fewer school absences and fewer home visits by a general practitioner. There was an increase in the readmission rate for the intervention group. A subgroup of patients who self managed by doubling their use of inhaled steroids during an exacerbation performed better than those patients who only increased their bronchodilator or were managed on salbutamol or sodium cromoglycate alone. Improvements in patient follow up and the structure of the self management plans used, particularly changing the peak flow level at which inhaled steroids are doubled, may further improve the outcome of patients attending the asthma clinic.