Adherence With Twice-Daily Dosing of Inhaled Steroids Socioeconomic and Health-Belief Differences

Abstract Poor adherence to medication regimens may be contributing to the recent increase in asthma morbidity and mortality. We examined patient characteristics that may influence adherence to twice-daily inhaled steroid regimens. In a multiple logistic regression analysis, less than 12 yr of formal education (OR: 6.72; CI: 1.10 to 41.0) and poor patient-clinician communication (OR: 1.2; CI: 1.01 to 1.55) were independently associated with poor adherence. These results emphasize the importance of socioeconomic status and adequate patient-clinician communication for adherence to inhaled-steroid schedules. 1998;157:1810-7) Andrea J. Apter, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030-3945

The effectiveness of one-on-one nurse education on the outcomes of high-risk adult and pediatric patients with asthma.

Forshee JD, Whalen EB, Hackel R, Butt LT, Smeltzer PA, Martin J, Lavin PT, Buchner DA Blue Care Network of East Michigan, Saginaw, USA. The effects of an asthma self-management program on asthma outcomes were evaluated in adult and pediatric patients with asthma who were considered at high risk (i.e., those who were not in control of their disease as determined by resource utilization, medication use, or lack of use). The program consisted of one-on-one nurse-to-patient ("nurse champion") education and subsequent assessment of asthma outcomes using the Asthma Quality Assessment System (AQAS) questionnaire, which measured asthma severity, patient quality of life, asthma awareness and knowledge, confidence in managing asthma, use of peak flow meters, asthma symptoms, medication use, lost work or school days, and affect of asthma. Over the course of six months, nurse champions educated 201 patients from four managed care plans and collected data at baseline and during four follow-up sessions. Adult patients and pediatric patient caregivers reported significant improvements in quality of life, and clinical and process measures. Significant increases in asthma knowledge were observed immediately after patient education, including greater than 89% increase in the proportion of patients who reported that they know "a lot" about the "things that cause asthma symptoms." Significant decreases were also found in work or school days missed, urgent care utilization, and hospital admission rates. Appropriate preventive care visits increased by more than 40%. These results indicate that the nurse champion program was associated with an improvement in asthma outcomes in high-risk adult and pediatric patients and warrant further evaluation in controlled studies. Incorporating one-on-one education programs into asthma management is an effective and rapid means of improving asthma outcomes.

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