Management of chronic disease by practitioners and patients: are we teaching the wrong things?BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7234.572 (Published 26 February 2000) Cite this as: BMJ 2000;320:572
Study No of patients Study design Follow up period Outcomes Jenkinson et alw1 177 RCT 3 and 12 months Significant knowledge increases (P=0.002)
No other significant change
Staudenmayer et alw2 40 Pre/Post 6 months Change in direction of fewer school absences (P=0.09)
Reduced No of emergency physician visits for those with baseline use (P=0.03)
Reduced No of hospitalisations (P=0.03)
Fireman et alw3 26 RCT 8-16 months Decreased school absences (P<0.05)
Reduced ED use (no statistical analysis)
Reduced hospitalisation time (no statistical analysis)
Lewis et alw4 76 RCT 1 year Reduced ED visits (P<0.001)
Reduced No of hospital days (P<0.01)
Hindi-Alexander and Croppw5 92 Pre/Post 1 year Reduced school absences (P<0.005)
Reduced ED use but not significant
No difference in hospitalisations
McNabb et alw6 14 Pre/Post 1 year Reduced ED use (no statistical analysis) LeBaron et alw7 31 RCT 4 months Increased knowledge about cromolyn (no statistical analysis)
No change in pulmonary function or systems
Rubin et alw8 54 RCT 1 year No difference in school absences
Improvement in ED use but not significant
Clark et alw9 310 RCT 1 year Improved academic performance (P<0.05)
Increased self management behaviour (parent P=0.0001, child P= 0.05)
No difference in school absences
Reduced ED use among those with baseline use (P=0.05)
Reduced hospitalisations among those with baseline use (P=0.05)
Mesters et alw10 67 RCT 1 year Higher level of asthma self efficacy (P<0.02)
Increased self management behaviour (P<0.01)
Decreased MD visits (P<0.01)
Wilson and Starr-Schneidkrautw11 80 RCT 1 year Increased symptom free days (P=0.004)
Fewer nights of parental sleep interruption
Rakos et alw12 43 RCT 1 year No significant difference in school absences
No significant differences in ED use or emergency MD visits
Mitchell et alw13 368 RCT 6 months Differences according to ethnicity of child
No differences in hospital days
Hughes et alw14 95 RCT 1 year Reduced school absences (P=0.04) McIntosh et alw15 92 RCT 4-6 months More treatment (35%) than control (17%) subjects reported more smoking outside their homes after test (and their children's cotinine levels were lower) but not significant Parcel et alw16 104 Comparison group 1 year Improved ED use but not significant
Higher levels of self efficacy regarding asthma (P=0.018)
Evans et alw17 239 RCT 1 year Increased self management (P=0.05)
Increased communication with parent (P=0.002)
Better academic grades (P=0.05)
Fewer days with symptoms (P=0.004)
Robinsonw18 74 Pre/Post 3 years Reduced school absences (no statistical analysis)
Better MDI technique (P=0.0005)
Fewer hospital days (P=0.02)
RCT=randomised controlled trial. ED=emergency department. MD=physician. MDI=metered dose inhaler.
Study No of patients Study design Follow up period Outcomes Allen et alw19 116 RCT 3, 6, 9, and 12 months Increased knowledge (P<0.0001)
Increased compliance (P<0.02)
No difference in morbidity
Bailey et alw20 225 RCT 1 year Better adherence to treatment regimens (P=0.0001) decreased
ED visits and hospitalisations, but difference from control group not significant
Bolton et alw21 241 RCT 4, 8, and 12 months Fewer ED visits (most significant at 4 months P=0.003, but still at 12 months P=0.005)
Reduction in ED charges by $628
Charlton et alw22 115 (69 adults, 46 children) Pre/Post Every 8 weeks for 1 year Reduced median No of MD visits (from 8.0 to 2.0 in peak flow education group and 4.5 to 1.0 in symptoms only education group)
Reduced use of oral corticosteroids
Garrett et alw23 500 adults and children RCT 9 months Increased ownership of peak flow meters (P=0.0001) and improved technique (children P<0.05, adults P<0.005)
Increased use of preventive drugs (adults P<0.05)
Increased self management plans (adults P<0.01)
Increased knowledge of action plan when symptoms worsened (children P<0.05, adults P<0.005)
No difference in compliance, hospital admissions, ED use, or days lost from school or work
Hilton et alw24 339 RCT 1 year Increased knowledge in maximum intervention group (P<0.05)
No difference in self management ability or asthma morbidity
Huss et alw25 52 Pre/Post 3 months Greater adherence scores for avoidance measures (P<0.05) Jenkinson et alw1 177 RCT 3 and 12 months Increased knowledge of drugs (after 3 months P=0.002, after 12 months P=0.007)
More significant increase in knowledge of intervention groups given tape than given only book (P=0.007)
Reduction in perception of disability
Kotses et alw26 76 RCT 2-12 months Reduced asthma attack frequency (P<0.05)
Decreased use of drugs (cromolyn sodium P<0.01, 2 agonists P<0.05)
Fewer asthma related problems (P<0.01)
Maiman et alw27 289 Factorial 6 months Fewer ED visits (P=0.05 with intervention from asthmatic nurse, self identified or not)
No significant results from booklet or non-asthmatic nurse plus booklet intervention
Mayo et alw28 104 RCT 32 months In treated v untreated patients, threefold reduction in readmission rate (P<0.004), twofold reduction in hospital day use (P<0.05)
In patients serving as their own controls, threefold reduction in readmission rate and hospital day use (P=0.003)
Moldofsky et alw29 62 RCT 16 months No significant retention of knowledge
No change in medical status
Osman et alw30 801 Factorial 1 year Fewer hospital admissions than control, by 54% (P<0.05) in those retained in clinic care and by 49% (95% CI 31% to 78%) in total intervention group
Less sleep disturbance by 80%
No significant difference in days of restricted activity, prescription of bronchodilators, inhaled corticosteroids, use of oral corticosteroids, No of MD consultants, or significant interaction between having a peak flow meter and education
Ringsberg et alw31 38 RCT 5 and 12 months Decreased No of hospital days (P=0.0001)
Reduced acute visits to hospital by 44%
No change in spirometric variables
Snyder et alw32 79 RCT 1, 2, and 3 months Increased knowledge (interaction effect, P<0.05)
Decreased No of attacks (1.93 v 2.87 weekly, P<0.05)
Yoon et alw33 76 RCT 5 and 10 months Fewer readmissions (educated group one seventh that of control, P<0.001)
Decrease in ED visits (P<0.001)
No difference in spirometric results, average PEF, or mean daily variability of PEF
Wilson et alw34 323 RCT 5 and 12 months Reduced "bother" due to asthma (P<0.05)
Increased physical activity (P<0.05)
Improved asthma, judged by MD (P<0.05)
Better environment control (P<0.0001)
Improved MDI technique (P<0.05)
Windsor et alw35 267 Pre/Post 12 months Improvement in inhaler skills use (95% CI 0.29 to 0.61), inhaler adherence (0.24 to 0.50), drug adherence (0.31 to 0.57), and total adherence (0.28 to 0.56)
Costs were $32.03/patient
Cost effectiveness was $96.09 for intervention group and $243.68 for control group
RCT=randomised controlled trial. ED=emergency department. MD=physician. MDI=metered dose inhaler.
- Jenkinson D, Davidson J, Jones S, Hawtin P. Comparison of effects of a self-management booklet and audiocassette for patients with asthma. BMJ 1988;297:267-70.
- Staudenmayer H, Harris PS, Selner JC. Evaluation of a self-help education-exercise program for asthmatic children and their parents: six-month follow-up. J Asthma 1981;18:1-5.
- Fireman P, Friday GA, Gira C, Vierthaler WA, Michaels L. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics 1981;68:341-8.
- Lewis CE, Rachelsfsky G, Lewis MA, de la Sota A, Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics 1984;74:478-86.
- Hindi-Alexander MC, Cropp GJA. Evaluation of a family asthma program. J Allergy Clin Immunol 1984;74:505-10.
- McNabb WL, Wilson-Pessano SR, Hughes GW, Scamagas P. Self-management education of children with asthma: AIR WISE. Am J Public Health 1985;75:1219-20.
- LeBaron S, Zeltzer LK, Ratner P, Kniker WT. A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication. Ann Allergy 1985;55:811-8.
- Rubin DH, Leventhal JM, Sadock RT, Letovsky E, Schottland P, Clemente I, et al. Educational intervention by computer in childhood asthma: a randomized clinical trial testing the use of a new teaching intervention in childhood asthma. Pediatrics 1986;77:1-10.
- Clark NM, Feldman CH, Evans D, Duzey O, Levison MJ, Wasilewski Y, et al. Managing better: children, parents, and asthma. Patient Educ Counseling 1986;8:27-38.
- Mesters I, Meertens R, Kok G, Parcel GS. Effectiveness of a multidisciplinary education protocol in children with asthma (0-4 years) in primary health care. J Asthma 1994;31:347-59.
- Wilson SR, Starr-Schneidkraut N. State of the art in asthma education: the US experience. Chest 1994;106(suppl):197-205S.
- Rakos RF, Grodek MV, Mack KK. The impact of a self-administered behavioral intervention program on pediatric asthma. J Psychosom Res 1985;29:101-8.
- Mitchell EA, Ferguson V, Norwood M. Asthma education by community child health nurses. Arch Dis Child 1986;61:1184-9.
- Hughes DM, McLeod M, Garner B, Goldbloom RB. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics 1991;87:54-61.
- McIntosh N, Clark NM, Howatt WF. Reducing tobacco smoke in the environment of the child with asthma: assisted minimal contact intervention. J Asthma 1994;6;453-62.
- Parcel GS, Nader PR, Tiernan K. A health education program for children with asthma. J Dev Behav Pediatr 1980;1:128-32.
- Evans D, Clark NM, Feldman CH, Rips J, Kaplan D, Levison MJ, et al. A school health education program for children with asthma aged 8-11 years. Health Educ Q 1987;14:367-79.
- Robinson LD. Evaluation of an asthma summer camp program. Chest 1985;87(suppl):105s.
- Allen RM, Jones MP, Oldenburg B: Randomized trial of asthma self-management programme for adults. Thorax 1995;50:731-8.
- Bailey W, Richards JJ, Brooks C, Soong S, Windsor R, Manzella B. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med 1990;150:1664-8.
- Bolton MB, Tilley BC, Kuder J, Reeves T, Schultz LR. The cost and effectiveness of an education program for adults who have asthma. J Gen Intern Med 1991;6:401-7.
- Charlton I, Charlton G, Broomfield J, Mullee MA. Clinical trial. randomized controlled trial. Evaluation of peak flow and symptoms only self-management plans for control of asthma in general practice. BMJ 1990;301:1355-9.
- Garrett J, Fenwich JM, Taylor G, Mitchell E, Stewart J, Rea H. Prospective controlled evaluation of the effect of a community-based asthma education centre in a multiracial working class neighbourhood. Thorax 1994;49:976-83.
- Hilton S, Anderson H, Sibbald B, Freeling P. Survey. Controlled evaluation of the effects of patient education on asthma morbidity in general practice. Lancet 1986;i:26-9.
- Huss K, Salerno M, Huss RW. Computer-assisted reinforcement of instruction: effects on adherence in adult atopic asthmatics. Res Nurs Health 1991;14:259-67.
- Kotses H. Bernstein I, Bernstein D, Reynolds R, Korbee L, Wigal J, et al. A self-management program for adult asthma. Part I: Development and evaluation. J Allergy Clin Immunol 1995;95:529-40.
- Maiman LA, Green LW, Gibson G, MacKenzie EJ: Education for self-treatment by adult asthmatics. JAMA 1979;241:1919-22.
- Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma. Ann Intern Med 1990;112:864-71.
- Moldofsky H, Broder I, Davies G, Leznoff A. Videotape educational program for people with asthma. Can Med Educ J 1979;120:669-72.
- Osman LM, Abdalla MI, Beattie JA, Ross SJ, Russell IT, Friend JA, et al. Reducing hospital admission through computer supported education for asthma patients. Grampian asthma study of integrated cate (GRASSIC). BMJ 1994;308:568-71.
- Ringsberg KC, Wiflund I, Wilhelmsen L. Education of adult patients at an "asthma school": Effects on quality of life, knowledge and need for nursing. Eur Respir J 1990;3:33-7.
- Snyder SE, Winder JA, Creer TL. Development and evaluation of an adult asthma self-management program: wheezers anonymous. J Asthma 1987;24:153-8.
- Yoon R, McKenzie D, Bauman A, Miles D. Controlled trial evaluation of an asthma education programme for adults. Thorax 1993;48:1110-6.
- Wilson SR, Scamagas P, German DF, Hughes GW, Lulla S, Coss S, et al. A controlled trial of two forms of self-management education for adults with asthma. Am J Med 1993; 94:564-76.
- Windsor RA, Bailey WC, Richards JM Jr, Manzella B, Soong SJ, Brooks M: Evaluation of the efficacy and cost effectiveness of health education methods to increase medication adherence among adults with asthma. Am J Public Health 1990;80:1519-21.
- This Week In The BMJ Published: 26 February 2000; BMJ 320 doi:10.1136/bmj.320.7234.0/g
- Editorial Published: 26 February 2000; BMJ 320 doi:10.1136/bmj.320.7234.525
- Learning In PracticeWhat should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi techniquePublished: 17 March 2005; BMJ 330 doi:10.1136/bmj.330.7492.633
- Learning In Practice Published: 17 March 2005; BMJ 330 doi:10.1136/bmj.330.7492.637
- Constitutional symptoms in a young personBMJ December 07, 2016, 355 i5781; DOI: https://doi.org/10.1136/bmj.i5781
- An adolescent with disabling abdominal painBMJ December 07, 2016, 355 i6101; DOI: https://doi.org/10.1136/bmj.i6101
- Andrew Wakefield calls Trump “on our side” over vaccines after meetingBMJ December 05, 2016, 355 i6545; DOI: https://doi.org/10.1136/bmj.i6545
- Doctors in Pakistan call for workers deported from the UAE to be screened for HIVBMJ December 05, 2016, 355 i6544; DOI: https://doi.org/10.1136/bmj.i6544
- Communicating risk to patients in the emergency departmentBMJ December 05, 2016, 355 i6437; DOI: https://doi.org/10.1136/bmj.i6437
- Improving the quality of life of people with advanced respiratory disease and severe breathlessness
- Republished: Perception of lung function, adherence to inhaled corticosteroids, and the role of peak expiratory flow feedback in paediatric asthma
- Perception of lung function, adherence to inhaled corticosteroids, and the role of peak expiratory flow feedback in paediatric asthma
- Changing education to improve patient care
- Impact of Physician Asthma Care Education on Patient Outcomes
- Traditional and patient-centred outcomes with three classes of asthma medication
- Preparing the 21st century global healthcare workforce
- What should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi technique
- The adolescent with a chronic condition. Part II: healthcare provision
- Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis
- Care for chronic diseases
- Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study * Commentary: Managing time appropriately in primary care
- A qualitative study of action plans for asthma
- Changing education to improve patient care
- NOSOLOGICAL ENTITIES?: Chronic facial pain: a multidisciplinary problem
- Improving Chronic Illness Care: Translating Evidence Into Action
- Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder
- Low dose inhaled corticosteroids and the prevention of death from asthma
- Benefits of Asthma Education Programs
- Preparation and training: the key to better patient involvement
- Patient preferences for autonomy in decision making in asthma management
- Advances in managing chronic disease