Trial of a “credit card” asthma self-management plan in a high-risk group of patients with asthma☆,☆☆,★,★★
Section snippets
Participant selection
From February to October 1991 casualty officers at Wellington Hospital invited adult patients with asthma who were treated for severe asthma in the emergency department and discharged, to attend a free “specialist” hospital outpatient clinic the following week. Patients who attended this initial outpatient clinic were enrolled in the trial if they lived in the Wellington region, had no uncontrolled concomitant medical problems, and were not being seen by a specialist chest physician. Patients
Attendance
During the 8-month recruitment period, 223 adult patients with severe asthma were treated and discharged from the emergency department of Wellington Hospital. Thirty-nine percent (86) of this target population accepted an invitation to attend the asthma clinic. Of these, 38 (44%) eventually attended the initial appointment, and 30 (35%) were considered eligible and were enrolled in the trial. Four subjects did not complete the trial: one withdrew because she had a recent diagnosis of myalgic
DISCUSSION
In this study we have found that the introduction of the credit card asthma self-management plan through a system of hospital-based specialist clinics is an effective method for improving asthma care in a high-risk group of emergency department patients. This high-risk group is characterized by many problems in long-term management, which are not met by the traditional health care system. Despite these difficulties, this program led to a decrease in asthma morbidity, as reflected in a 65%
Acknowledgements
We thank the participants in the program, Dr. Heather Leslie and the staff of the Wellington Hospital Emergency Department, and Sister O’Leary and the staff at Wellington Hospital Main Outpatient Clinics. We also thank Christine Culling and Bridget Robson for help in conducting interviews, Gordon Purdie for statistical advice, and Simon Lewis for graphical assistance.
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From the Department of Medicine, Wellington School of Medicine.
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Supported by the Health Research Council of New Zealand. The Wellington Asthma Research Group is funded by a Programme Grant from the Health Research Council of New Zealand, Neil Pearce and Julian Crane are funded by Senior Fellowships of the Health Research Council of New Zealand, and Wendyl D’Souza was funded by a Research Fellowship from the Asthma Foundation of New Zealand and is now funded by a Research Fellowship from the Health Research Council of New Zealand.
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Reprint requests: Richard Beasley, FRACP, DM, Department of Medicine, Wellington School of Medicine, PO Box 7343, Wellington South, Wellington, New Zealand.
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