The Science Journal of the American Association for Respiratory Care
A therapist-directed outpatient asthma management program was instituted at our facility in Nov. 1997. The foundation of this program is grounded in recommendations from NAEPP's Expert Panel Report II published that same year. The program goals included 1) enhancement of patient self-management through education and follow-up, 2) decreased Emergency Room (ER) and hospital utilization, and 3) complement/supplement to physician management of asthma. Key components of the program include: easy access upon physician referral, one-on-one assessment and education, individual care plan development, intensive and ongoing monitoring which includes outpatient visits and telephone follow-up, and medication management following NIH guidelines. The Purpose of this study was to determine the effectiveness of this program on frequency of ER visits and hospitalizations for acute exacerbations of asthma.
Methods: Between Nov. 97 and August 1998, 67 patients were referred to the program. Patient profiles identified: 84% of patients were female, 52% Caucasian, 42% African-American and 6% other. Ninety percent of the patients were over 17 years of age. Patient's asthma status was rated on admission based upon the NIH classification system. Eighty percent were admitted with moderate persistent (Step 3) or severe persistent (Step 4) asthma. Eight patients received education only (no follow-up) and nine were dropped due to non-compliance (85% compliance). Patients included in the study were active in the program for a minimum of 8 weeks and had outcome data available and monitored for a minimum of 6 months. Fifty patients met these criteria. These fifty patients served as their own controls in a ?mirrored? evaluation from the point of referral into the Asthma Management Program. This allowed for comparison of ER and hospitalization rates at our institution for similar periods of time for each patient, before and after starting the program. Statistical analysis was done using paired t-test.
Results: When comparing pre-program to post-program values at greater than 95% confidence levels, positive outcomes are demonstrated.
|n = 50||ER Visits X (SD)||Hospitalizations X (SD)|
|Pre-Program||1.54 (2.99)||0.40 (0.57)|
|Post-Program||0.22 (0.58)||0.12 (0.39)|
Conclusions: In our program, the benefits of individualized education, self-monitoring, aggressive supervision and medication management have all contributed to significant reductions in ER visits as well as hospital admissions at our facility. These improved outcomes demonstrate that a Therapist-Directed asthma management program can be effective in assisting asthmatic patients in their self-management initiatives.