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.


METHODS
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.


METHODS
Hospital outpatient clinics and general practices in north east Scotland.


METHODS
801 adults attending hospital outpatient clinics, with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%.


METHODS
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.
Osman
L M
LM
Health Services Research Unit, University of Aberdeen.
Abdalla
M I
MI
Beattie
J A
JA
Ross
S J
SJ
Russell
I T
IT
Friend
J A
JA
Legge
J S
JS
Douglas
J G
JG
D000553:Ambulatory Care; D001249:Asthma / Q000628:therapy*; D003194:Computer-Assisted Instruction; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D012017:Referral and Consultation; D012606:Scotland; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome