A Randomized Controlled Trial of Follow-up of Patients Discharged From the Hospital Following Acute Asthma: Materials and Methods

All patients > 16 years of age and admitted to the hospital with acute asthma between October 2000 and October 2003 were eligible for the trial. Asthma was diagnosed by BTS criteria. Patients were excluded if they had COPD or were unable or unwilling to consent to the study. Patients attending the emergency department but not being admitted were not included in the study, as they would generally have had a milder attack (peak expiratory flow > 50% of predicted or best or > 60% after nebulization) and would not normally be offered a routine follow-up appointment in the respiratory clinic. Recruitment was undertaken by an independent clinical research nurse who identified all patients shortly after hospital admission and visited them prior to discharge to discuss the study. Reading here

After written consent was obtained, the patients were randomly assigned using a randomized envelope system administered by the clinical research nurse, to be seen by the respiratory doctor or a respiratory specialist nurse at follow-up from the hospital admission. The respiratory nurse specialist had experience as a nurse in primary care prior to several years as a respiratory nurse specialist in secondary care. The nurse was a qualified nurse practitioner and had received specialist training in acute and chronic asthma management. Their formal training included “The Education for Health Asthma Diploma” (a UK national course) and a Master of Science degree (dissertation on acute asthma management). The outpatient specialists were blinded as to which follow-up group the patient was assigned until hospital discharge. Ethical approval was given by West Suffolk Research and Ethics Committee.

Patients were admitted with asthma from the emergency department according to BTS guidelines and were managed by a general physician on a respiratory ward according to an agreed integrated care pathway. However, if appropriate, advice was sought from the respiratory doctor responsible for the patient’s management.
All patients enrolled into the trial received an initial 30-min hospital follow-up appointment at 2 weeks after discharge with the respiratory doctor or specialist nurse. Fifteen-minute follow-up appointments were then arranged as believed necessary by either specialist. There were no set criteria for adding follow-up appointments. All patients were asked to attend a 6-month follow-up appointment. The consultations in either arm of the study consisted of an evaluation of the events leading to the hospital admission; an assessment of the patients’ understanding of their asthma; initiation or reinforcement of asthma education; an assessment of their understanding of asthma therapy; assessment of inhaler technique; a self-management plan; and appropriate change in asthma medication. The specialist nurse prescribed independently according to an agreed asthma protocol (patient group directive). The self-management plan provided was based on changes in peak flow and symptoms.

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