Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Alabama (cont'd)
Asthma Self-Management Program
University of Alabama at Birmingham
Connie Kohler, DrPH
The prevalence and impact of adult asthma are substantial, and poor self-management practices, especially failures to adhere to treatment regimens, appear to be a significant problem. Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education resources. A comprehensive program was developed in Birmingham, AL that integrated a workbook with one-to-one counseling and adherence-enhancing strategies.
The self-management program included a one-hour one-on-one counseling session conducted by a health educator. The patient received a peak flow meter and was instructed on how to use it. The intervention focused on the self-care workbook that included information on the proper use of medications, self monitoring and self evaluation techniques, early detection of impending attacks, and attack management. Patients also took part in asthma support groups lead by the health educator. The support groups reviewed information from the individual sessions and encouraged patients to share their concerns. The health educator made phone calls two and four weeks post initial encounter to encourage self management.
A longitudinal one-year study compared patients receiving this self-management program with "usual care" patients receiving standard asthma pamphlets. Patients were randomly assigned to conditions. Baseline score and asthma severity were statistically controlled. After one-year self-management patients had substantially better adherence than usual care patients at follow-up, including symptoms, medication use, and inhaler technique. Hospital and emergency department visits decreased in both groups but did not differ between groups. The self-management program ended in 1994, but was approached by the American Lung Association to adapt the program to a community setting, and become a community asthma education program nationwide. The adapted program, Breathe Well Live Well, is currently being pilot tested at several community sites in Alabama.
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