PURPOSE: To assess the effect of both a cognitive and behavioral modification program on health care visits and various quality of life issues and to assess the efficacy of a non-physician run program in a physician community.
METHODS: Over 6 years, Island physicians referred 860 patients (613 Paediatric, 247 Adults) to a Certified Asthma Educator nurse/respiratory therapist run center. A minimum of 3 visits over 6 months took place using behavior modification principles, repeated spirometry and technique testing. Immediate feedback to primary care and referring physician was generated.
RESULTS: Adult hospital admissions decreased from 53 to 2. Hospital days decreased from 203 to 6. Paediatric admissions decreased from 103 to 6 while days spent in hospital decreased from 295 days to 17 days. Emergency room visits dropped from 521 to 82 for Paediatrics and 213 to 32 for adults. Paediatric and adult ICU admissions were reduced from 9 to none. Total number urgent visits to family physician or specialist dropped from 1044 to 151 for paediatrics and from 418 to 65 for adults (85% drop in urgent physician visits). Significant improvements were reported in shortness of breath, nighttime awakenings, days without wheeze and cough and days missed from school or work.
CONCLUSIONS: The Asthma Education Centre(AEC) patients significantly reduced their emergency room usage, acute-care physician visits and hospitalizations, supporting the argument that providing a prevention and education based program is highly cost-effective compared to treatment in the acute care setting. Patients who participate in the AEC program reduced the disruptions in their lives and improved their overall quality of life. The AEC has been able to demonstrate a significant reduction in the use of valuable and limited resources available to the PEI Health Care system.
CLINICAL IMPLICATIONS: All patients with diagnosis of asthma should be referred to an Asthma Education Centre for ongoing education in collaboration with physician follow-up.
DISCLOSURE: The following authors have nothing to disclose: Mitchell Zelman, Carol McClure, Judy Hansen, Janette Conklin
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