Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?

作者：Sheares Beverley J^*; Mellins Robert B; Dimango Emily; Serebrisky Denise; Zhang Yuan; Bye Michael R; Dovey Mark E; Nachman Sami; Hutchinson Vincent; Evans David

来源：American Journal of Respiratory and Critical Care Medicine, 2015, 191(12): 1374-1383.

DOI：10.1164/rccm.201407-13380C

• asthma
• action plans
• physicians
• minority
• self-management

Rationale: Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.
Objectives: To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.
Methods: A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.
Measurements and Main Results: Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], p-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001).
Conclusions: Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma.

• 出版日期2015-6-15