Original articleTwo short interventions to reduce health care requirements in asthma patients. A multicentre controlled study (ASTHMACAP II)Dos cortas intervenciones reducen la utilización de recursos sanitarios en los pacientes asmáticos. Estudio multicéntrico controlado (ASMACAP II)
Introduction
Asthma is a chronic disease that affects 6% of the European population.1 Treatment of this condition has advanced considerably, but the current rate of asthma-related mortality remains high2 and control of the condition continues to be suboptimal in Europe,1, 3 the United States,4 and Canada.5 This deficiency in asthma management, which was also evidenced in our country in the pilot report of the present study (ASMACAP I),6 is attributed in part to a lack of adherence to the treatment prescribed.7 The overall result is excessive use of healthcare resources and frequent visits to the emergency room,1, 5 which culminates in considerable health expenditure.8
Various interventions have been carried out in several studies to improve adherence to asthma treatment.9 The conclusion obtained is that asthma clinical control is better when the intervention involves education, self-monitoring, regular review, and patient-directed self-management using a written self-management action plan (Evidence A).10, 11 It has been shown that improved asthma control is associated with reductions in healthcare utilization and related cost12, 13; hence, the use of these interventions is recommended in daily practice. Nonetheless, these clinical interventions require a certain amount of time during the medical consultation, and general practitioners (GPs) may have too large a workload to effectively implement them. For this reason, the experts continue to underline the need for innovative interventions that are short and easy to carry out.14
The aim of this study was to determine the effectiveness of two short comprehensive educational interventions based on an explanation of the contents of a small booklet in asthma patients whose treatment was adequately adapted according to the Global Initiative for Asthma (GINA) guidelines.14 The ultimate objectives were to improve the patients’ knowledge of the disease and how to control it, and to reduce the use of primary health care services and work absenteeism.
Section snippets
Study design (Fig. 1)
Throughout 2005 and 2006, a prospective, randomized, controlled, multicenter comparative study in asthma patients was carried out, involving two educational interventions performed in 5 min with the help of an educational booklet.
Patients (Fig. 2) (socio-demographic and clinical data in Table 2)
Participants aged 15–70 years were recruited in primary care centres (PCCs) from the lists of patients with a diagnosis of asthma, established by the attending GP. Following authorization by their physicians, patients were invited to participate in the study by
Results
A total of 479 patients were recruited for the study. Three hundred and thirty-four patients completed the study with all data recorded, 168 in the intervention group and 166 in the control group (Fig. 2). Their sociodemographic and clinical data are shown in Table 2. After randomization 145 patients were lost to follow-up, the vast majority of them due to lack of interest to attend the study visits, despite the systematic insistence of the researchers. There were no significant differences in
Discussion
The main finding of this study performed in the primary care setting is that after adjusting treatment in both the intervention and control groups, fewer visits to the health services and absences from work were required in asthma patients receiving two short interventions lasting 5 min, carried out with the help of an illustrated, informative booklet. These findings are in keeping with the results obtained in other studies using more comprehensive interventions and support the idea that
Contributors
FM contributed to the design, was the coordinator all along the study, and was responsible for the writing of the manuscript. IO contributed to collecting and interpreting the data, and revised the writing of the manuscript. RC recruited and visited the patients, and revised the writing of the manuscript. IU recruited and visited the patients, and revised the writing of the manuscript. RA recruited and visited the patients, and revised the writing of the manuscript. JG recruited and visited the
Ethical approval
This study was approved by the Ethics Committees of the five referral Hospitals.
Data sharing
No additional data available.
What is already known on this topic
Clinical asthma control is better when the intervention plan involves education, self-monitoring, regular reviews and patient-directed self-management using a written self-management action plan.
What this study adds
Improved asthma control can be achieved in primary care with two short comprehensive interventions using an illustrated booklet. The result is a decrease in the use of health resources and work absenteeism.
Funding
This work was supported by a competitive grant from Astra Zeneca/FUCAP (Fundació Catalana de Pneumologia) and a primary care grant from IDIAP Jordi Gol.
Conflict of Interest
The authors declare no conflicts of interest.
Acknowledgments
The authors thank Dr. Carlos Sanjuás for his help in the use of the study questionnaires, Dr. Joan Martí for the design and preparation of the study, Ana Salas and Clara Coll for database management, Rosa Llòria for manuscript preparation, and Celine Cavallo for English language support.
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All members are listed in Appendix A.