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Standard versus patient-centred asthma education in the emergency department: a randomised study

¹ Centre for Evidence-Based Medicine, Dept of Primary Health Care, University of Oxford, Oxford, UK, ² School of Medicine, University of Queensland, Herston, ³ Dept of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, and ⁴ Dept of Medicine, Mater Adult Public Hospital, Raymond Terrace, South Brisbane, Australia.

CORRESPONDENCE: S. Smith, University of Oxford, Centre for Evidence-Based Medicine, Dept of Primary Health Care, Old Road Campus, Headington, Oxford, OX3 7LF, UK. Fax: 44 1865289336. E-mail: smithsm01{at}yahoo.com.au

Keywords: Asthma, emergency department, patient education

Received: May 3, 2007
Accepted January 6, 2008

High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain. The present study aimed to compare the effectiveness of patient-centred education (PCE) and standard asthma patient education on ED re-attendance.

A randomised controlled trial was conducted at two inner-city Australian teaching hospitals’ EDs, where patients received either standard patient education (SPE) or PCE. Both groups received a six-topic curriculum. However, PCE patients reordered the topics according to their own priority and thus controlled the order of education.

In total, 146 adult patients presenting to EDs with acute asthma were enrolled. After 4 months, ED re-attendance decreased from 22 to 12% in the PCE group and remained unchanged in the SPE group (between group odds ratio 0.4, 95% confidence interval (0.2–1.1)). In 78 patients discharged after ED care, the PCE group had fewer re-attendances after 4 and 12 months (0.3 (0.1–0.9) and 0.3 (0.1–0.8), respectively ). PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months (0.1 (0.0–0.7) and 0.2 (0.0–0.6), respectively). A trend of better asthma control was evident, with a reduction in activity limitation.

In conclusion, patient-centred education offers promise as a brief education process in the emergency department. However, a large multicentre trial of patient-centred education is required.