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Interventions to improve the management of asthma in primary care settings

Creator:

Lozano, P., Schaefer, J., Finkelstein, J., Stout, J., Wagner, E. and Weiss, K.

Subject Keywords: Asthma
Topic: Chronic Conditions
Type: Article
Region: International (other)
Description:

The Global Initiative for Asthma (GINA 2002), in its Practical Guide to Asthma Management provides an evidence-based management strategy that addresses severity assessment, pharmacotherapy, monitoring, environmental control and the patient-provider partnership (GINA 2002). Despite the existence of effective therapies, including inhaled anti-inflammatory and long-acting bronchodilators, current practice falls short of guidelines and consequently, inadequate asthma control continues to be the norm. Although evidence based guidelines have been established, there is significant variation among practitioners in treating this condition, indicating a significant gap between what we know is optimal care and current practice (Finkelstein 2000, Finkelstein 2002, Lozano 2003). We propose to undertake a review of interventions to improve the management of asthma in primary care. A variety of approaches have been taken to improve asthma care including; patient self-management support, provider directed education and behavior change, and organizational approaches. Considerable work has been done in reviewing patient self-management support interventions. For example, Gibson found that information only patient education programs did not appear to improve outcomes (Gibson 2001). Toelle found insufficient evidence about the effectiveness of written management plans for adults and children (Toelle 2001). Reviews of more complex self-management interventions have shown positive results: self-management support education for children directed at prevention and attack management showed demonstrably improved outcomes (Wolf 2002). Positive outcomes were found in studies of asthma education for adults that included self-monitoring of either peak flow or symptoms, when combined with regular medical review and a written action plan (Gibson 2002). Another review of multifaceted adult interventions showed equivalent effects for control of asthma management by regular medical review of inhaled corticosteroid use vs. control by self-adjustment using written self management plan (Powell 2002). To complement these reviews, we will focus our review on provider-directed interventions and organizational approaches, only including patient-oriented interventions when they are part of a multi-focus study. The objectives of this review are to determine the effectiveness of various interventions to improve the management of asthma in primary care settings.

Date:

20/10/2003

Rights: © The Cochrane Collaboration
Suggested citation:

Lozano, P., Schaefer, J., Finkelstein, J., Stout, J., Wagner, E. and Weiss, K.. (2003) Interventions to improve the management of asthma in primary care settings [Online]. Available from: http://publichealthwell.ie/node/4408 [Accessed: 19th July 2019].

  

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