BMJ 1994;308:568-571 (26 February)

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Reducing hospital admission through computer supported education for asthma patients

L M Osman, M I Abdalla, J A G Beattie, S J Ross, I T Russell, J A Friend, J S Legge, J G Douglas,  on behalf of the Grampian Asthma Study of Integrated Care (GRASSIC)

Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD Thoracic Medicine Unit, Aberdeen Royal Hospitals Trust, City Hospital, Aberdeen AB9 8AU Correspondence and reprint requests to: Ms L M Osman, Centre for Medical Education, University of Edinburgh, 11 Hill Square, Edinburgh EH8 9DR.

Abstract

Objective : To evaluate a personalised computer supported education programme for asthma patients.
Design : Pragmatic randomised trial comparing outcomes over 12 months between patients taking part in an enhanced education programme (four personalised booklets, sent by post) and patients receiving conventional oral education at outpatient or surgery visits.
Setting : Hospital outpatient clinics and general practices in north east Scotland.
Subjects : 801 adults attending hospital outpatient clinics, with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%.
Main outcome measures : Numbers of hospital admissions, consultations with general practioner for asthma, steroid courses used, bronchodilators and inhaled steroids prescribed, days of restricted activity, and disturbed nights.
Results : Patients with asthma judged too severe for randomisation between clinic care and integrated care and thuse retained in clinic care had 54% fewer hospital admissions after receiving enhanced education than did the control group (95% confidence interval 30% to 97%; P<0.05) over the study year. Patients had not all spent a full year as "educated" patients within the study year: when"educated days" were controlled for, annual admission rates for the entire enhanced education group were 49% (31% to 78%) of those in the control group. Among patients with sleep variation, sleep disturbance in the education group in the week before a regular review was 80% (65% to 97%) of that in the control group. There was no significant difference in days of restricted activity, prescription of bronchodilators or inhaled steroids, use of oral steroids, or number of general practioner consultations for asthma, and no significant interaction between ownership of a peak flow meter and education.
Conclusions : An asthma education programme based on computerised booklets can reduce hospital admissions and improve morbidity among hospital outpatients.

Clinical implications

  • Clinical implications

  • When patients received booklets on asthma management, personalised to their own prescribed drug their hospital admission rates were estimated to be reduced by 51%

  • Patients prefer information on managing asthma attacks, breathing techniques, and the drug they have been prescribed for control of asthma

  • Written information on managing asthma can be delivered to large numbers of patients in personalised booklets by using existing database and mail merge software

  • Such interventions enhance patients' understanding and control of their asthma and reduce hospital costs for asthma admissions


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