Self-management education and regular practitioner review for adults with asthma

 

Abstract

Background

A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes.

Objectives

The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma.

Search methods

We searched the Cochrane Airways Group trials register and reference lists of articles.

Selection criteria

Randomised trials of self-management education in adults over 16 years of age with asthma.

Data collection and analysis

Two reviewers assessed trial quality and extracted data independently. We contacted study authors for confirmation.

Main results

We included thirty six trials, which compared self-management education with usual care. Self-management education reduced hospitalisations (relative risk (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82); emergency room visits (RR 0.82, 95% CI 0.73 to 0.94); unscheduled visits to the doctor (RR 0.68, 95% CI 0.56 to 0.81); days off work or school (RR 0.79, 95% CI 0.67 to 0.93); nocturnal asthma (RR 0.67, 95% CI 0.0.56 to 0.79); and quality of life (standard mean difference 0.29,CI 0.11 to 0.47). Measures of lung function were little changed.

Authors' conclusions

Education in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan improves health outcomes for adults with asthma. Training programmes that enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.

 

Plain language summary

Self-management education and regular practitioner review for adults with asthma

Guidelines for the treatment of asthma recommend that patients be educated about their condition, obtain regular medical review, monitor their condition at home with either peak flow or symptoms and use a written action plan. The results of trials comparing asthma self-management education to usual care were combined. These results showed that asthma sufferers who were educated about their asthma, visited the doctor regularly and who used a written action plan had fewer visits to the emergency room; less hospital admissions; better lung function; improvement in peak expiratory flow; fewer symptoms; and used less rescue medication.

 

摘要

背景

對於氣喘成人患者的自我管理教育及常規

許多氣喘管理準則的一個關鍵組成部分，是建議實施病人教育和定期醫療檢查。許多的對照試驗已進行了氣喘教育方案效率的量測。這些方案改善病人的知識，但其導致的健康結果並不太明確。進行這項審查來檢驗支持澳大利亞氣喘管理計劃步驟6：教育，並定期檢討以測試健康結果是否受教育和自我管理的方案影響的證據的強度。

目標

這次審查的目標是評估氣喘自我管理方案加上定期健康醫生的檢查，對成人氣喘病患的健康狀況的影響。

搜尋策略

我們檢索了the Cochrane Airways Group trials register及文獻的參考書目。

選擇標準

超過 16歲的氣喘成年人病患自我管理教育的隨機試驗。

資料收集與分析

兩名審查員獨立的評估試驗品質和分析數據。我們聯繫了研究的作者以對資料進行確認。

主要結論

我們囊括了36個試驗有關自我管理教育與常規護理的比較。自我管理教育減少住院的次數(相對危險度(RR)0.64，95％信賴區間(CI)0.50～0.82)；急診次數(RR 0.82，95％CI為 0.73～0.94);不定期的就醫次數(RR 0.68， 95％CI為 0.56～0.81);無法上班或上學的天數(RR0.79，95％CI為 0.67～0.93);夜間氣喘發作的次數(RR 0.67，95％CI為 0.0.56至0.79)和生活品質(標準平均差0.29 ，CI 0.11至0.47)。肺功能的量測值變化不大。

作者結論

在氣喘的自我管理中教育包含了使用尖峰呼氣流速或症狀來自我監控，再加上定期回診和書面行動計劃改善了成人氣喘的健康成果。訓練課程使人們能夠使用書面行動計劃來調整其藥物使用，且似乎比其他形式的氣喘自我管理更為有效。

翻譯人

本摘要由臺北醫學大學萬芳醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

氣喘自我管理教育對病人是有重大利益的。氣喘治療準則建議患者應該被教育有關他們的狀況、定期回診、再加監控自身的狀況透過尖峰流量或症狀並使用書面的行動計劃。試驗的結果比較了氣喘自我管理教育和常規治療。這些結果顯示氣喘患者被教育了有關其氣喘症狀，定期就診及使用了書面行動計劃，減少了急診次數；減少住院次數；有更好的肺功能，改善尖峰呼氣流速，減少症狀的產生，並減少使用急救藥物。