PROSPECTIVE CONTROLLED EVALUATION OF THE EFFECT OF A COMMUNITY-BASED ASTHMA EDUCATION CENTER IN A MULTIRACIAL WORKING-CLASS NEIGHBORHOOD

Background - Previous work has indicated a high rate of non-attendance at hospital based clinics among young, multiracial asthmatic patients of lower socioeconomic class. The efficacy of delivering asthma educa tion from a community health centre established in a multiracial worki ng class neighbourhood was evaluated. Methods - A prospective controll ed study was performed in which asthmatic subjects aged between two an d 55 years attending a hospital emergency room with acute asthma and l iving within a defined geographical area of high emergency room users were randomised to the usual follow up or the education centre plus us ual follow up. Measurements were taken at entry into the study and aga in nine months later. Results - At nine months patients randomised to the education centre had more preventive medications, more peak expira tory flow meters and better flow meter technique, more self-management plans, better knowledge of appropriate action to take when confronted with worsening asthma, less nocturnal awakening, and better self-repo rted asthma control than the control group. There was no difference be tween the study groups in measurements of compliance, hospital admissi on, days lost from school or work, or emergency room use. Conclusions - The main effects of education were on asthma knowledge and self-mana gement skills, whilst improvements in asthma morbidity were small. Pot ential reasons for this include heterogeneous study population (in ter ms of baseline self-management skills, asthma severity, ethnicity and age), pragmatic study design, insensitivity of many of the measurement s of morbidity, the modest effectiveness of a single time limited educ ation programme, and inability to limit the effects of such a large co mmunity based study to the intervention group (there was a 67% reducti on in asthma admissions during the study period from the geographical area targeted compared with a 22% reduction for the rest of Auckland).