2004 OPEN FORUM Abstracts
Asthma Education Intervention by Respiratory Therapists Improves Clinical Outcomes with Provider Behavior Change Modification
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.