The Science Journal of the American Association for Respiratory Care

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.

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