2004 OPEN FORUM Abstracts
INTEGRATION OF ADULT ASTHMA EDUCATION INTO A PHYSICIAN VISIT
Ashley
F. Dulle, RRT, AE-C and Patricia M. Williams, PhD; Section of
Occupational and Environmental Medicine LSU Health Sciences Center,
Shreveport, LA
Background:
Current data suggests that education as an integral part of asthma
management can increase positive health outcomes for patients.
However, the optimal method for delivering asthma education is still
undecided.
Method: This study evaluated the effectiveness of
an asthma education program integrated into a physician office visit
to determine if health outcomes were improved in a population of
impoverished minorities. During a routine physician office visit a
certified asthma educator evaluated adult patients with a diagnosis
of asthma. The patients completed questionnaires based on the
National Asthma Education and Prevention Program guidelines. Topics
included in the questionnaire were environmental triggers, symptom
frequency, and health care usage. The patients were educated on
asthma patho-physiology as well as trigger avoidance and control. The
patient was seen by the physician for their physical exam. The
physician and the asthma educator discussed the findings and together
developed the management plan for the patient. Immediately
thereafter, the patient returned to the asthma educator for education
on medication usage, dosage, and peak flow meter use. Patients were
also given an action plan based on both symptoms and peak flow
measurements. At every physician office visit, patients completed a
follow-up questionnaire on symptom frequency, health care use, and
medication problems. Patients then received follow-up education on
any problem areas detected. Such problem areas were also relayed to
the physician who worked with the educator to alter the management
plan if needed.
Results: From June 2002 to June 2004 a total
of 261 patients attended the initial education session. Of those, 151
patients returned for their follow-up physician office visits and
educational sessions. Data was collected using the questionnaires and
comparing pre-education versus post. Missed work or school days
(where applicable) were decreased 90% per 6-month period. Emergency
department visits were decreased 81% per 6 months, and
Hospitalizations were decreased 91% per one year. According to the
EPA Cost of Illness publication these figures equate to a healthcare
savings of $361,952.86 or $1,734.79 per patient.
Conclusion:
Integrating asthma education into a physician office visit will
greatly increase the health outcome of the patient by decreasing
healthcare usage, as well as decreasing missed work or school days.
By incorporating the education with the physician office visit, the
educator and the physician are in communication on-site and are able
to develop an optimal treatment plan for the patient. However, when
education is incorporated into an office visit there is no allowable
financial reimbursement. This is possibly the reason numerous other
studies have looked at group education or educational sessions
separate from an office visit. Consequently, these other studies do
not have the level of improvement shown here. One limiting factor to
this study is the lack of follow-up, only 58% of the patients
returned for follow-up. Reasons for this are unclear and future study
is needed on effect of depression and stress on asthma management and
treatment outcomes in an impoverished minority population.