The goals of this study are to translate a successful asthma education program to patients who are treated in the emergency department (ED). This proposal is part of a trajectory of patient-oriented clinical research aimed at improving outcomes in asthma patients. It builds on two prior successful studies. The first, supported by the Robert Wood Johnson Foundation, is a completed study with 224 adult primary care patients that showed that less patient self-efficacy, more depressive symptoms, and unrealistic expectations of treatment predicted deterioration in quality of life and increased urgent resource utilization over 2 years. These findings led to an ongoing NHLBI K23 randomized controlled trial to implement a multi-component education intervention with 180 adult primary care asthma patients. Preliminary results from this trial indicate that this intervention is effective in improving quality of life and urgent resource utilization. Therefore, the specific aim of this proposed randomized controlled trial is to test an intervention to enhance knowledge, self-efficacy and asthma-related social support in 296 adult patients being treated for asthma in two EDs in New York City. The intervention will be administered during a single in-person session in the ED (or hospital for admitted patients) followed by telephone reinforcement. The primary outcome will be the within-patient change in overall Asthma Quality of Life Questionnaire scores from enrollment to 8 weeks. Additional outcomes at 8 and 16 weeks will be the amount of beta agonists used, peak flow rates, work absenteeism, urgent resource utilization, and cost-effectiveness of the program. The novel features of this program are: it is easy to administer; it focuses on ED patients who are in great need of asthma education; and it incorporates self-efficacy, an important aspect of asthma self-management that has not been rigorously tested in ED programs. The long-term objectives are to foster programs in the ED, a setting that has been underserved regarding asthma education, by providing evidence that cost-effective and clinically effective programs can be successfully implemented. Other long-term objectives are to use the program as a basis for similar programs for children, adolescents and their caregivers in the ED, primary care, and school settings. ? ?
| Mancuso, Carol A; Choi, Tiffany N; Westermann, Heidi et al. (2013) Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity. J Asthma 50:103-7 |
| Mancuso, Carol A; Peterson, Margaret G E; Gaeta, Theodore J et al. (2012) Time to seeking emergency department care for asthma: self-management, clinical features at presentation, and hospitalization. J Asthma 49:275-81 |
| Peterson, Margaret G E; Gaeta, Theodore J; Birkhahn, Robert H et al. (2012) History of symptom triggers in patients presenting to the emergency department for asthma. J Asthma 49:629-36 |
| Mancuso, Carol A; Peterson, Margaret G E; Gaeta, Theodore J et al. (2011) A randomized controlled trial of self-management education for asthma patients in the emergency department. Ann Emerg Med 57:603-12 |
