| Methods |
The subjects were randomized into 2 groups: one receiving subsequent visits from the asthma nurse until discharge from hospital (n = 35) and a control group (n = 30), which received 'routine care' from medical and nursing staff but no further intervention from the asthma nurse |
| Participants |
A group of 80 patients (53 women), with an age range of 16 to 72 years (mean 36.1 years) was recruited. Patients who had been admitted on the general medical take to a large teaching hospital with a documented primary diagnosis of acute asthma were recruited for the study. Patients were not permitted to participate if they: (1) had underlying chronic obstructive pulmonary disease; (2) had previously participated in an educational program from a hospital‐based asthma nurse; (3) were unable or unwilling to complete a series of follow‐up questionnaires |
| Interventions |
The education program took place over a minimum of 2 separate sessions, lasting on average 30 minutes each, and was carried out on an individual basis. The first session involved discussion on the basic mechanisms of asthma, including common triggers and an explanation of the changes which occur to the airways resulting in the symptoms experienced by the patient. This was supported by illustrations in the 'Regular Therapy with Asthma' booklet, which was given to each intervention group patient. Lifestyle influences, such as occupation and leisure activities were discussed where appropriate to the individual. The need for 'preventer' and 'reliever' medication was also emphasized during this session. Patients were encouraged to actively participate in the session and relatives were included at the patients' request. The second session took place on the following day. Previously given information was briefly summarized with input from the patient as a means of checking understanding. An agreed individualized self‐management plan was determined, with written instructions using the 'Sheffield Asthma Card'. This also contained a telephone contact number. Each patient was given a peak low meter to take home and instructions on monitoring, with documentation of predicted peak low measurement and parameters for altering treatment, as well as clear written guidelines on when to seek emergency care. Home intervention was based upon a combination of symptoms and peak low recordings and all guidance offered throughout the educational program was based on the British Thoracic Society (BTS) guidelines for the management of asthma in adults. A final visit was made to each patient where possible prior to discharge at which they were encouraged to express any fears or anxieties relating to their home managements |
| Outcomes |
Compliance was measured by questionnaire at 6 months
Clinical health outcomes included: (1) Occasions of GP call‐outs and re‐admission; (2) Patients percentage of claiming to have a writing management plan; (3) Percentage of the compliance of using beta‐agonist inhaler regularly everyday; (4) first line action and (5) BPRS and GAS scores |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
No details were given in the article. "The subjects were then randomized into two groups: one receiving subsequent visits from the asthma nurse until discharge from hospital (women = 62.5%) and a control group which received 'routine care' from medical and nursing staff but no further intervention from the asthma nurse (women = 67.5%)" (pg 852) |
| Allocation concealment (selection bias) |
Unclear risk |
No information was provided about how allocation was handled |
| Selective reporting (reporting bias) |
Unclear risk |
No protocol available; although it appears that everything was reported it is difficult to determine this without a protocol |
| Other bias |
Unclear risk |
No objective criteria for measuring outcomes ‐ even hospital utilization is measured by questionnaire to GPs. Written consent was obtained from GPs, verbal from patients |
| Blinding of outcome assessment (detection bias)
Adherence measure |
Unclear risk |
(PRIMARY) SELF REPORT ‐ QUESTIONNAIRE ‐ No information on blinding given. There is insufficient information to permit judgment of 'Low risk' or 'High risk' |
| Blinding of outcome assessment (detection bias)
Patient outcome |
Unclear risk |
(PRIMARY) FIRST‐LINE ACTION ‐ No information on blinding given. There is insufficient information to permit judgment of 'Low risk' or 'High risk' |
| Blinding of participants (performance bias)
Adherence measure |
High risk |
(PRIMARY) SELF REPORT ‐ QUESTIONNAIRE ‐ Patient would have been aware of their own group, subjective outcome |
| Blinding of participants (performance bias)
Patient outcome |
Unclear risk |
(PRIMARY) FIRST‐LINE ACTION ‐ This is a subjective measure; there is no information on blinding |
| Blinding of personnel (performance bias)
Adherence measure |
Unclear risk |
(PRIMARY) SELF REPORT ‐ QUESTIONNAIRE ‐ No information on blinding given. There is insufficient information to permit judgment of 'Low risk' or 'High risk' |
| Blinding of personnel (performance bias)
Patient outcome |
Unclear risk |
(PRIMARY) FIRST‐LINE ACTION ‐ No information on blinding given. There is insufficient information to permit judgment of 'Low risk' or 'High risk' |
| Incomplete outcome data (attrition bias)
Adherence measure |
Unclear risk |
(PRIMARY) SELF REPORT ‐ QUESTIONNAIRE ‐ No information was given about reasons for dropouts |
| Incomplete outcome data (attrition bias)
Patient outcome |
Unclear risk |
(PRIMARY) FIRST‐LINE ACTION ‐ No information was given about reasons for dropouts. Number of questionnaires were not similar between the groups |
