Asthma self-management - Do patient education programs always have an impact?

Background: During the past 15 years, programs to improve self-management p ractices in adults with asthma have reported improvement in functional stat us and reduction of inappropriate use of health care services. However, the se programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be effica cious, it is important to replicate the programs as well as to evaluate les s complex methods that may be more appropriate for nonacademic health care settings. Methods: We compared the following 3 standardized self-management treatment s in a randomized, controlled trial: (1) a replication of the self-manageme nt program developed at a university medical center that was previously sho wn 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 ill ness, 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 gr oups did no better than the usual-care group. Conclusions: The results are inconsistent with the results of the first ast hma self-management study at this institution and with those of efficacy st udies 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 selfmanagement programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect pa tient outcomes was substantially reduced.