[In-patient asthma education and self-management training in clinical practice--a national survey in Germany].
BACKGROUND
According to international guidelines patient education is a key component of modern asthma-management. Especially in rehabilitation, patient training is considered essential for long-term treatment success. Based on growing empirical evidence for clinical efficacy of asthma self-management training, standardized education programs as well as guidelines and recommendations for quality management in health care practice have been developed.


OBJECTIVE
Due to the lack of evidence [empirical data] on compliance to these recommendations we conducted a nation-wide survey including in-patient pneumological clinics in Germany.


METHODS
Exploiting address registers of national asthma organizations (i. e. Deutsche Atemwegsliga) we identified 75 clinics that offer education programs on a regular basis, 65 of which participated in this study (drop-out-rate: 12 %). These institutions were asked to complete a questionnaire in order to assess various aspects of their education practice.


RESULTS
Although 91 % of clinics reported to adhere to guidelines and recommendations for patient education, merely 50 % supplied standardized and evaluated education and self-management training programs. A rather small proportion (19 %) was found to fully adhere to protocol (maximum treatment integrity, no mixing of different education schemes). Furthermore, substantial variance between clinics was observed in actual performance of asthma education, the major indicators being: indication criteria and eligibility of patients; education contents; group size, duration and frequency of sessions; extent and intensity; didactical methods; number and qualification of trainers; measures of quality management, and settings. Accordingly, a consistent standard of patient education in rehabilitation practice has not yet been achieved.


CONCLUSIONS
While substantial advances in the proposition of patient education and self-management trainings in in-patient health care remain unquestioned, there are some deficits in actually performing such programs in clinical practice. Results also show that another question needs to be addressed: qualifying trainers. Less than half of trainers participating in this study reported to have absolved a train-the-trainer-course.
Mühlig
S
S
Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen, Germany. muehlig@uni-bremen.de
Rinne
H
H
Mehren
F
F
Petermann
F
F
Butt
U
U
Worth
H
H
D001249:Asthma / Q000523:psychology / Q000534:rehabilitation*; D004521:Educational Measurement; D005858:Germany; D017408:Guidelines as Topic; D006306:Health Surveys; D006801:Humans; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D012042:Registries; D012648:Self Care