There has been increasing interest in improving
self management through patient education.
A recent meta-analysis of randomised
trials of programmes to teach self management
to children with asthma showed that these programmes
had surprisingly little effect on
morbidity.11 This may have been because the
teaching programmes had not been designed
for specific target groups—well defined by age,
setting, disease severity, and therapeutic protocol.
In contrast, a recent programme for adults
with asthma in Aberdeen showed a significant
effect when self management plans were
introduced.12 Days in hospital and visits to outpatients
were reduced, as were consultations in
general practice and severity of symptoms. In
another Scottish study, a one year clinical trial
of asthma care in children identified clear
evidence that structured nurse-led discharge
planning and follow up can substantially
reduce morbidity, with a fall in the readmission
rate from 25% in the control group to 8% in
the intervention group over the subsequent 12
months.9 Such intensive education requires
considerable time and commitment by staff.