Promoting the use of Personal Asthma Action Plans: a systematic review.
OBJECTIVE
To investigate how best to encourage health professionals to promote, and for people with asthma to use, asthma action plans.


METHODS
Systematic review. Randomised controlled trials published between 1960 and 2006 were searched using multiple electronic databases. Unpublished and ongoing studies were identified by contacting asthma experts internationally. Included trials reported outcome data for the promotion of action plans including issue of plans by health professionals, and patient ownership and use.


RESULTS
14 trials satisfied our study inclusion criteria. Of these, only four studies reported data for action plan use. Interventions included: education of doctors and people with asthma; telephone reinforcement; partially completed action plans and postal prompts inviting patients for general practice review; school asthma clinics; and asthma management systems (including the 3+ plan with patient recall for review and Internet-based physician monitoring). These interventions increased action plan ownership, use, or facilitation of use. Two of the highest quality papers were conducted in primary care and demonstrate the effectiveness of interventions directed at the organisation of asthma care in promoting action plan use.


CONCLUSIONS
Primary care professionals could encourage the ownership and use of action plans through the implementation of proactive practice-based organisational systems, though further research is required to assess their practicality and effect on sustaining use long-term. Multi-disciplinary teams working in areas where asthma action plan ownership and use is sub-optimal should therefore consider how such interventions could be incorporated into existing practices and healthcare systems.
Ring
Nicola
N
Alliance for Self-Care Research, Department of Nursing & Midwifery, University of Stirling, Stirling, FK9 4LA, Scotland, UK. nicola.ring@stir.ac.uk
Malcolm
Cari
C
Wyke
Sally
S
Macgillivray
Steve
S
Dixon
Diane
D
Hoskins
Gaylor
G
Pinnock
Hilary
H
Sheikh
Aziz
A
D001249:Asthma / Q000628:therapy*; D006282:Health Personnel; D006293:Health Promotion; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D006113:United Kingdom