"You can make a significant difference when patients get involved in their own care," says William Bria, M.D., co-director of the U-M Asthma-Airways Clinic. "There probably is not a chronic disease that wouldn't benefit from this approach, including diabetes and heart disease. It pays off over and over and over again."
Bria and his colleagues monitored the progress of 90 people participating for one year in the asthma clinic, which emphasizes the need for patients to manage their own care. Specifically, patients are taught how to recognize asthma signs and symptoms, appropriately alter the dosage of their medications, manage drug side effects, control panic, identify and avoid factors that trigger asthma episodes, and communicate effectively with their doctors. In between office visits, nurses call patients to evaluate their progress and help them build problem-solving skills.
The researchers found statistically significant reductions in every category they measured---the number of hospitalizations, emergency room visits, unscheduled office visits, days spent ill and days out of work. Those results, Bria says, show the promise of changes now transforming health care.
"The era of hospital-centered care is over," he says. "The trend is now toward the maturation of the health care system and more self-management by patients."
Men and women in the U-M study both experienced benefits from the asthma clinic's self-management principles, but women consistently benefited more---a phenomenon the researchers intend to investigate further.
Bria is scheduled to discuss the program and the evaluation of its results at the 1998 conference of the American Lung Association and American Thoracic Society in Chicago, scheduled from April 24-29.
Asthma is the most common chronic respiratory condition in the United States, and the number of cases has increased during the past five years. A recent analysis of the disease's economic impact concluded it costs $6.2 billion a year---and more than half of that results from hospitalization and emergency room visits.
A medical strategy that significantly reduces the need for those services, Bria says, clearly reduces the cost of asthma and increases patients' quality of life.