What Are Some Strategies to Enhance Asthma Education in My Practice?
Primary-care offices are typically very busy places. As a result, the educational needs of parents and children with asthma often go unmet.1 Lack of time is a common reason reported for not providing asthma education in the primary-care setting.2 However, providing asthma care consistent with the National Asthma Education and Prevention Program Expert Panel Report 3 (NAEPP EPR-3) Guidelines for the Diagnosis and Management of Asthma, which includes self-management education, does not have to be time consuming. One study evaluated the effects on patients 2 years after pediatricians were taught by their peers to enhance their skills in asthma therapies and counseling. This study found that pediatricians who participated in the training benefited in important ways. Trained physicians received higher patient-rated performance scores regarding communication behaviors important to promoting patient’s satisfaction and ability to manage asthma on their own, and in addition, their patients were also less likely to incur disruption of sleep caused by asthma symptoms. Another important finding of this study was that these positive results were achieved even though there was no difference in the time that peer-trained physicians spent with their asthma patients when first diagnosing a patient, seeing a new patient, or seeing a return patient. In fact, the peer-trained physicians spent less time with patients during urgent visits.3 Such a method for enhancing education in your practice requires changing physician behavior.
System-level changes have also been evaluated. In one such study, researchers evaluated the effectiveness of 2 asthma-care improvement strategies in the primary-care setting. One was less time consuming and less expensive and consisted of peer leader education. The other was more intensive and more expensive and consisted of allocating a nurse to conduct planned asthma-care visits. This group also received peer education. Findings revealed that, although both strategies decreased asthma symptom days, the peer leader group did not reach statistical significance.4 Therefore, when attempting to enhance educational practices in your office, it may be more effective to institute changes that target systems-oriented improvements, for example, developing a system that ensures all patients with asthma receive a written asthma action plan as per NAEPP EPR-3 Guidelines. One way to accomplish this is to automate the process by using an electronic medical record system. Such an approach makes it easy for the provider, legible for the patient and family, and a permanent part of the medical record. If instituting an electronic medical record is not feasible in your practice, having asthma action plans that are preprinted with medication names allowing you to check off or circle the treatment prescribed or having asthma action plans with a preprinted short-acting beta-agonist so that you only need to write the long-term control medications are 2 time-saving options. Creative shortcuts can also be useful. For example, color-coded labels for long-term control and quick-relief medications can be preprinted and then added to the action plan at the end of the visit. An example of such a plan can be found in Figure 39-1. All action plans described allow for individualization in an efficient manner.
Figure 39-1. Sample written asthma action plan with preprinted labels.
Having written asthma action plans is only one step in the process for enhancing education in your office; using them is an even more important step. To encourage use of the action plans in your office, it is important to keep them readily available. Some suggestions include keeping the asthma action plans in each exam room so that they are easily accessible during each patient visit or having them clipped to the front of each asthma patient’s chart before the visit begins.
Another method for enhancing education in your practice is to make resources available to your patients and to view each opportunity as a teachable moment. For example, providing patients and families with internet opportunities (such as the Quest for the Code asthma game found at www.asthma.starlight.org) for self-education while they are sitting in the waiting room or providing them with a list of resources (Table 39-1) that they can access at their convenience allows them to learn at their own pace. However, it is extremely vital to recognize that merely providing patients and families educational materials without providing explanation is not true education. All educational materials and resources provided to patients must be reviewed and reinforced by all members of your health care team. One way to accomplish this is to develop asthma-specific visit forms that include a list of key educational messages. This list can be used to prompt providers to introduce or review a message or messages at each visit. Thus, providing consistent and repeated educational messages by all members of your health care team is another step to enhancing education in your practice.
An alternative or supplementary method for providing self-management education and addressing key educational messages is to offer asthma education classes and resources in your office. Asthma education classes allow you to personally review important self-management concepts in a group setting, thus promoting efficiency as well as education. Numerous examples and forms (print, audio-video, online) of asthma educational resources are available that can also be tailored to meet the needs of an individual practice.
Two final recommendations for enhancing education in your practice include hiring a nationally certified asthma educator to provide education during patient visits as well as via telephone in between visits, and developing a system for referring patients who need additional education to asthma specialists. Both of these strategies are supported by the NAEPP EPR-3 Guidelines. The Guidelines recommend using health professionals and others trained in asthma self-management education to implement and teach asthma self-management. They also recommend referring patients who need additional education to improve adherence to asthma specialists.5 National certification for asthma educators has been available since 2002; thus, it is relatively new, and the effectiveness of education provided by certified asthma educators has not been reported. However, numerous randomized controlled studies have reported improved asthma outcomes when patients and families were educated by someone specially trained in asthma care and self-management.6
There are many options for enhancing education in your practice; some are more labor-intensive and costly than others. Developing a system that fits within the confines of your practice makes quality asthma education accessible to all of your patients with asthma and their families, and using all members of your health care team is the best approach to enhancing asthma education in your practice.
1. McMullen A, Yoos HL, Anson E, Kitzmann H, Halterman JS, Sidora Arcoleo K. Asthma care of children in clinical practice: do parents report receiving appropriate education? Pediatric Nursing. 2007;33:37-44.
2. Peterson MW, Strommer-Pace L, Dayton C. Asthma patient education: current utilization in pulmonary training programs. J Asthma. 2001;38:261-267.
3. Clark NM, Cabana M, Kaciroti N, Gong M, Sleeman K. Long-term outcomes of physician peer teaching. Clin Pediatr. 2008;47:883-890.
4. Lozano P, Finkelstein JA, Carey VJ, et al. A multisite randomized trial of the effects of physician education and organizational change in chronic asthma care. Arch Pediatr Adolesc Med. 2004;158:875-883.
5. National Asthma Education and Prevention Program. Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma. Section 5: managing exacerbations of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007:373-417.
6. Coffman JM, Cabana MD, Halpin HA, Yelin EH. Effects of asthma education on children’s use of acute care services: a meta-analysis. Pediatrics. 2008;121:575-586.