Impact of patient education and self-management on morbidity in asthmatics and patients with chronic obstructive pulmonary disease

Abstract

The effect of patient education on morbidity in asthmatics and COPD patients has not previously been investigated in a single study. We randomized 78 asthmatics and 62 COPD patients after ordinary outpatient management. Intervention consisted of educational group sessions and individual sessions administered by a trained nurse and physiotherapist. A self-management plan was developed. The utilization of health resources and absenteeism from work was self-reported monthly. During the 12-month follow-up, approximately two (P = 0.001) and three (P = 0.001) times as many uneducated asthmatics and COPD patients, respectively, visited their general practitioner (GP) compared with educated. The mean reduction in GP consultations for the educated were 73% (P < 0.001) and 85% (P < 0.0001) for the asthma and COPD group, respectively, compared with uneducated. Fifty percent of uneducated asthmatics reported absenteeism from work compared with 24% of the educated (P = 0.06). The mean reduction in days off work for the educated was 69% (P = 0.03), compared with uneducated.A positive correlation was observed between St George's Respiratory Questionnaire total score and number of GP visits for both the asthma and COPD group (P < 0.001). We conclude that patient education in asthmatics and COPD patients reduced the need for GP visits and kept a greater proportion of patients independent of their GP. Patient education among asthmatics also reduced the number of days off work and appeared to increase the proportion of patients not reporting absenteeism from work at all. Increasing number of GP visits was correlated with decreased health-related quality of life as measured by the SGRQ for both the asthmatics and the COPD patients. (C) 2000 HARCOURT PUBLISHERS LTD.