In the sixth in our series featuring the ïinformation for patients and professionalsÍ section from the latest evidence-based guidelines from SIGN, we reproduce the patient education and self-management section from the British Guideline on the Management of Asthma, published jointly by SIGN and The British Thoracic Society.
Personalised asthma action plans
Written personalised action plans as part of self-management education have been shown to improve health outcomes for people with asthma. The evidence is particularly good for those in secondary care with moderate to severe disease, and those who have had recent exacerbations. There is a relative paucity of evidence for benefit in primary care and in very young children. This may be due to the difficulty of demonstrating benefit in comparatively mild patients or may reflect the need for a less formal self-management plan in these patients.
Offer self-management education, including written asthma action plans focusing on individual needs, to all patients with asthma, particularly those admitted to hospital.
Asthma action plans should be written and focus on individual needs. They may be based on symptoms and/or peak flows (depending on age and ability). They may include the provision of an emergency course of steroid tablets. The term ïaction planÍ is proposed as a replacement to the existing ïself-management planÍ. It reflects patient terminology preferences (unpublished data from the National Asthma Campaign), may be perceived as less daunting and is appropriate when working with parents and carers as well as adult patients.
Successful interventions have been delivered by trained asthma healthcare professionals, usually doctors and nurses in the UK, and have been supported by educational discussion. Many published studies report long, intensive programmes. However, there is evidence that short programmes are as effective, and that usual care can be raised to a standard that incorporates many of the core elements of the extensive successful programmes (see Checklist 1 below). Self-management programmes will only achieve better health outcomes if the prescribed asthma treatment is appropriate and within guideline recommendations.
Introduce asthma action plans as part of a structured educational discussion.
Patient education and self-management tools
A number of educational tools are available to support health professionals, many of which are free, well researched and non-promotional. Amongst these are the Be in Control materials produced by the National Asthma Campaign, accessible from the website (www.asthma.org.uk/control) or by contacting the organisation. Annex 8 of the guideline reproduces the National Asthma Campaign asthma action plan. Additional support and information for patients and carers is also available from the National Asthma Campaign website (www.asthma.org.uk) and their nurse run helpline: 0845 701 0203.
Patient education and self-management in practice
The programmes evaluated used a wide range of approaches, making it difficult to give definitive advice. Checklists 1 and 2 are drawn from components of successful programmes, and may be useful when developing educational and organisational aspects of asthma care.
Every asthma consultation is an opportunity to review, reinforce and extend both knowledge and skills. This is true whether the patient is seen in primary care, the accident and emergency department or the outpatient clinic. It is important to recognise that education is a process and not a single event.
- A hospital admission represents a window of opportunity to review self-management skills. No patient should leave hospital without a written asthma action plan.
- An acute consultation offers the opportunity to determine what action the patient has already taken to deal with the exacerbation. Their self-management strategy may be reinforced or refined and the need for consolidation at a routine follow up considered.
- A consultation for an upper respiratory tract infection or other known trigger is an opportunity to rehearse with the patient their self-management in the event of their asthma deteriorating.
- Brief simple education linked to patient goals is most likely to be acceptable to patients.
|Checklists to aid patient education and self-management|
|Adapted from: British Guideline on the Management of Asthma. Edinburgh and London: Scottish Intercollegiate Guidelines Network and The British Thoracic Society, January 2003. Published as a supplement to Thorax 2003; 58(Suppl 1).|