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Reducing hospital admission through computer supported education for asthma patients. Grampian Asthma Study of Integrated Care (GRASSIC)

OBJECTIVE: To evaluate a personalised computer supported education programme for asthma patients. DESIGN: Pragmatic randomised trial comparing outcomes over 12 months between patients taking part in an enhanced education programme (four personalised booklets, sent by post) and patients receiving conventional oral education at outpatient or surgery visits. SETTING: Hospital outpatient clinics and general practices in north east Scotland. SUBJECTS: 801 adults attending hospital outpatient clinics, with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. MAIN OUTCOME MEASURES: Numbers of hospital admissions, consultations with general practitioner for asthma, steroid courses used, bronchodilators and inhaled steroids prescribed, days of restricted activity, and disturbed nights. RESULTS: Patients with asthma judged too severe for randomisation between clinic care and integrated care and thus retained in clinic care had 54% fewer hospital admissions after receiving enhanced education than did the control group (95% confidence interval 30% to 97%; P < 0.05) over the study year. Patients had not all spent a full year as "educated" patients within the study year: when "educated days" were controlled for, annual admission rates for the entire enhanced education group were 49% (31% to 78%) of those in the control group. Among patients with sleep variation, sleep disturbance in the education group in the week before a regular review was 80% (65% to 97%) of that in the control group. There was no significant difference in days of restricted activity, prescription of bronchodilators or inhaled steroids, use of oral steroids, or number of general practitioner consultations for asthma, and no significant interaction between ownership of a peak flow meter and education. CONCLUSIONS: An asthma education programme based on computerised booklets can reduce hospital admissions and improve morbidity among hospital outpatients.

Trial
Journal Ref. Osman LM, Abdalla MI, Beattie JA, Ross SJ, Russell IT, Friend JA, et al: Reducing hospital admission through computer supported education for asthma patients. Grampian Asthma Study of Integrated Care (GRASSIC). BMJ 1994, 308:568-571.
Intervention Behavioural change (patients) - four printed booklets on asthma management covering both regular control and action in acute episodes
Number of sites 4
Countries involved 1
Sample size 801
Type of statistical analyses Means and 95% confidence intervals estimates
Risk of bias Overall: Unclear details
Participant characteristics Age: 47-52
Condition: Asthma
Baseline severity: diagnosis of asthma confirmed by a chest physician, and have shown pulmonary function reversibility of at least 20%
Duration of trial October 1989 and December 1990
Primary outcome ITT Means and 95% confidence intervals estimated from Poisson regression models
Effect Measures
Events Intervention Total Events Control Total Risk Diff.
0 323 0 315 0.00 %
Ratio of mean outcomes, education over control (95% confidence interval) 0.49 (0.31 to 0.78)
Show Score Ranges

Scores:

(shows median if more than one score was entered)

Elig. Recr. Setting Org. Int. Flex. Del. Flex. Adherence Follow-Up Prim. Out. Prim. An.
5 4 5 4 5 5 4 3 5