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, Old Road Campus, Oxford OX3 7LF, United Kingdom
² School of Medicine, University of Queensland, Herston Road, Herston 4006 Australia;; and Dept of Respiratory Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba 4102, Australia and;
³ Dept of Medicine, Mater Adult Public Hospital, Raymond Terrace, South Brisbane 4101, Australia

^* To whom correspondence should be addressed. E-mail: sheree.smith{at}dphpc.ox.ac.uk.

	Abstract

High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as one potential cause of re-attendances and the optimal format of education is uncertain.

To compare the effectiveness of patient centred and standard asthma patient education on ED re-attendances.

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

One hundred forty-six adult patients presenting to EDs with acute asthma were enrolled. At 4 months, ED re-attendances decreased from 22% to 12% in PCE group and were unchanged in the SPE group (between group OR 0.4; 95% CI 0.2 to 1.1). In patients discharged after ED care (n=78), the PCE group had fewer re-attendances at 4 and 12 months (OR 0.3, 95%, CI 0.1 to 0.9; OR 0.3 95% CI 0.1 to 0.8). PCE patients with no GP care in the prior 7 days had fewer re-attendances at 4 and 12 months (OR 0.1, 95% CI 0.0 to 0.7; OR 0.2, 95% CI 0.0 to 0.6). A trend of better asthma control was evident with a reduction in activity limitation.

PCE offers promise as a brief education process in the ED. However, large multi-centre trial of PCE is warranted.

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