2005 OPEN FORUM Abstracts
MINIMAL ASTHMA EDUCATION SIGNIFICANTLY DECREASES EMERGENCY ROOM VISITS AND HOSPITAL UTILIZATIONAnne E. Kwiatkowski, B.Ed, RRT, AE-C
Linda M. Bury, RRT, CPFT St. Vincent Mercy Medical Center, Toledo, OH
Background: Poor patient compliance in our outpatient education program prompted us to question effectiveness of program.
Methods: We evaluated 195 patients who were referred to our outpatient education program between January of 2002 and May of 2005. The patients were divided into 2 groups: those referred but did not attend our program (131), and those who only attended the initial session (64). Of the 131 patients who did not attend any session, 49% had documented emergency room or hospital utilization during our time of focus. Of the 64 that attended at least an initial visit, 45% had utilization prior to referral, and 54% had no utilization noted. Following initial education, only 3 (4%) of those patients had an emergency room or hospital visit. Sixteen people continued attending the program after the initial session; ten have completed or are currently enrolled. Our initial session includes a pre-test of information presented in the program, discussion of the disease state, patient medications to include their purpose and proper administration techniques, and peak flow or symptom monitoring depending on patient age. Patients receive printed materials for home referral and study, a peak flow meter, a holding chamber, and a diary to chart either peak flow numbers or symptoms. A follow-up appointment is scheduled between two and four weeks after the initial visit. At the second appointment, we discuss triggers, and determine effectiveness of the patient's medications based on their completed diaries. If the patient continues to be symptomatic, i.e. having symptoms more than 2 times per week, as per NIH guidelines, and/or circadian variance of peak flows > 10%, we contact the referring physician to discuss possible medication changes. If changes are made, we have the patients continue charting for an additional two to four weeks to determine improvement. At the second or third appointment; depending when control is ascertained, we write an early intervention plan that is sent to the physician for their approval. A copy of the approved plan with physician signature is then sent to the patient for their personal use. Approximately three months later, we perform a telephone follow-up to determine the patient's progress, and clarify any patient questions. The final visit occurs approximately one year after their initial appointment. At this visit the patient is administered a post-test, which is the same as the pre test, and a follow-up questionnaire. Adjustment of peak flow zones for children is performed when needed, and an incentive gift and a certificate of completion are given to each patient. Patients are sent home with a program evaluation form and a self addressed return stamped envelope.
Results: 195 patients were referred to our outpatient education program. Of those, 131 patients did not attend our sessions; 49% of who had documented emergency room or hospital utilization during our time of focus. 45% of the 64 patients who attended at least an initial visit, had a history of hospitalizations or emergency room visits prior to education. Of that group, only three patients (4%) had repeat utilization after education.
Conclusions: The information given at the first asthma education session is important and needs to be concise to warrant results lest the patient does not return. Correct inhaler technique is a crucial component to that visit. Often the patient never receives instruction on proper inhaler techniques resulting in decreased medication effectiveness. Our study reveals that patients do benefit from information about their disease process, and can learn to manage it themselves with minimal, but necessary and appropriate education from qualified asthma educators.