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Do Patient Education Programs Always Have an Impact?

William C. Bailey, MD; Connie L. Kohler, DrPH; James M. Richards, Jr, PhD; Richard A. Windsor, PhD, MPH; C. Michael Brooks, EdD; Lynn B. Gerald, PhD, MSPH; Beverly Martin, BS, RN; Darlene M. Higgins; Tiepu Liu, MD, DrPH

Arch Intern Med. 1999;159:2422-2428.

Background  During the past 15 years, programs to improve self-management practices in adults with asthma have reported improvement in functional status and reduction of inappropriate use of health care services. However, these programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be efficacious, it is important to replicate the programs as well as to evaluate less complex methods that may be more appropriate for nonacademic health care settings.

Methods  We compared the following 3 standardized self-management treatments in a randomized, controlled trial: (1) a replication of the self-management program developed at a university medical center that was previously shown to be efficacious; (2) a modified version of this program including only the core elements; and (3) a usual-care program. Outcome measures included medication and inhaler regimen adherence, asthma symptoms, respiratory illness, functional status, and use of health care resources.

Results  All 3 groups improved on measures of respiratory illnesses, use of health care services, and functional status. Patients in both education groups did no better than the usual-care group.

Conclusions  The results are inconsistent with the results of the first asthma self-management study at this institution and with those of efficacy studies of similar programs. Two factors, selection of the patient population and historical changes in asthma treatment, most likely contributed to the lack of impact of the self-management programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect patient outcomes was substantially reduced.

From the Lung Health Center, Division of Pulmonary and Critical Care Medicine (Drs Bailey, Richards, Brooks, and Gerald and Mss Martin and Higgins), the School of Public Health (Dr Kohler), the School of Education (Dr Windsor), and the School of Health-Related Professions (Drs Brooks and Gerald), University of Alabama at Birmingham; the Veterans Affairs Medical Center, Birmingham (Dr Bailey); and the Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Liu).

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