2004 OPEN FORUM Abstracts
Asthma Education Intervention by Respiratory Therapists Improves Clinical Outcomes with Provider Behavior Change Modification
Candace
Ramos, RRT, BHS, AE-C, Susan Thomas, RRT, MHSA, AE-C, Section of
Allergy, Asthma, Immunology, The Children’s Mercy Hospital,
Kansas City, MO
Introduction:
The method by which primary care providers (PCPs) treat and manage
asthma patients has a direct effect on patient outcomes. National
guidelines have been published and widely distributed to PCPs, yet
clinicals practice patterns have not evolved into better patient
management. An educational intervention utilizing Respiratory
Therapists (RTs) has resulted in provider behavior change at the
primary care level. The change in practice patterns is imperative to
positively affect clinical as well as financial outcomes.
Objective:
The objective of this intervention was to develop a disease
management program that will alter the behavior of PCPs from ‘crisis
management’ to those that have been shown to improve patient
outcomes. The preferred behaviors include making an appropriate
diagnosis, providing asthma education, utilizing an asthma action
plan, and prescribing controller medication for persistent
asthmatics.
Methods:
We utilized RTs as asthma educators in community primary care offices
for an intensive intervention to achieve preferred provider
behaviors. The RTs used a combination of didactic presentations,
problem based learning, hands-on practice, case consultation, and
positive reinforcement, training both the providers and their staff.
We measured changes in diagnosis and prescription patterns, asthma
knowledge, satisfaction of asthma patient care provided, asthma
action plans written and asthma education completed.
Results:
After we completed the intervention at the selected provider offices,
our results are as follows: 1) An increased in the number of patients
diagnosed with asthma (4.4%), 2) Improvement in the number of
reliever to controller medication ratio prescribed for persistent
asthmatics (2.5 to 1.3), 3) Enhanced knowledge of asthma disease and
management (25% for staff, 13% for providers), 4) Increased
utilization of asthma action plans (23%), 5) Incorporated asthma
education into office visits (7%), 6) Improved satisfaction with the
asthma patient care delivered in the practice (22%).
In
addition to the improved clinical outcomes, we also achieved the
following financial benefits: 1) Reduction of asthma related
emergency department (ED) visits and hospitalizations (2.1% ED, 7.1%
Hospitalizations), 2) Reduction of the number of ‘frequent
fliers’ (33%), 3) Reduction of the overall cost of healthcare
for asthma patients in the affected offices (52%).
Conclusions:
An asthma education intervention provided by Respiratory Therapists
can produce positive provider behavior changes that lead to improved
asthma patient care. In turn, financial aspects of healthcare
utilization for asthma patients can be improved with better patient
management. A side benefit of this program is a noticeable
improvement in patient self management skills, which we are currently
analyzing.