A systematic review of randomized control trials evaluating the effectiveness of interactive computerized asthma patient education programs

doi:10.1016/S1081-1206(10)60727-2

Annals of Allergy, Asthma & Immunology

Volume 98, Issue 6, June 2007, Pages 507-516

https://doi.org/10.1016/S1081-1206(10)60727-2 Get rights and content

Background

Educating patients with asthma about the pathophysiology and treatment of their disease is recommended. In recent years, several computer programs have been developed to provide this education. These programs take advantage of the population's increasing skill with computers and the growth of the Internet as a source of health care information.

Objective

To evaluate the effectiveness of published interactive computerized asthma patient education programs (CAPEPs) that have been subjected to randomized controlled trials (RCTs).

Data Sources

The PubMed, ERIC, CINAHL, Psychinfo, and Clinicaltrials.gov databases were searched (through October 3, 2005) using the following terms: asthma, patient, education, interactive, and computer.

Study Selection

RCTs in English that evaluated the effect of an interactive CAPEP on the following primary end points were included in the study: hospitalizations, acute care visits, rescue inhaler use, or lung function. Secondary end points included asthma knowledge and symptoms. Trials were screened by title and abstract before full text review. Two independent investigators used a standardized data extraction form to identify the articles chosen for full review.

Results

Nine of 406 citations met inclusion criteria. Four CAPEPs were computer games, 7 only studied children, and 4 focused on urban populations. One study each showed that the intervention reduced the number of hospitalizations, acute care visits, or rescue inhaler use. Two studies reported lung function improvements. Four studies showed improvement in asthma knowledge, and 5 studies reported improvements in symptoms.

Conclusions

Although interactive CAPEPs may improve patient asthma knowledge and symptoms, their effect on objective clinical outcomes is less consistent.

Section snippets

INTRODUCTION

Although education of asthma patients as a means of improving medication compliance and outcomes has been recommended by national medical organizations,1, 2 traditional limited asthma patient education efforts have not generated significant improvements in hospitalization rates, physician visits, lung function, or medication use.³ In contrast, education programs designed to enhance self-management when used together with regular practitioner review can decrease hospitalizations, emergency

METHODS

The PubMed, ERIC (Educational Resources Information Center), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Psychinfo, and Clinicaltrials.gov databases were searched (through October 3, 2005) using the following search terms: asthma, patient, education, interactive, and computer. Search terms were truncated and used in various combinations. Reference lists of pertinent articles were searched, and when appropriate, investigators were contacted by e-mail concerning ongoing

RESULTS

The search produced 406 citations. After screening for RCTs, use of an interactive CAPEP, and the required objective outcome measures, 9 studies were chosen for inclusion. Two potential (ongoing, unpublished) clinical trials were identified by searching clinicaltrials.gov. The investigators of these 2 trials were contacted by e-mail. One study was excluded because it did not use interactive computer technology.⁷ The other study⁸ evaluated an interactive CAPEP but was not included in this review

DISCUSSION

Our hypothesis at the outset of this review was that patient education is an important aspect of asthma patient care, and since our society is becoming increasingly computer literate, we postulated that computer-based educational programs hold promise for delivering critical information about asthma pathophysiology and management to patients. Although most of the studies reported in this review showed a positive impact on patients’ understanding of asthma, we did not observe similarly strong

ACKNOWLEDGMENTS

We thank Dr Cynthia Mulrow, professor of medicine, Audie L. Murphy Veterans Hospital, San Antonio, Texas, for her advice and book,²⁸ which provided excellent reference material in performing this review. Additionally, we thank Dr E O’Brian Smith, professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, for his assistance with data analysis, and Dr Henry I. Bussey, Jr, professor, College of Pharmacy, University of Texas at Austin, and senior editor of Clotcare at //www.clotcare.com

CME Examination

1-5, Bussey-Smith KL, Rossen RD. 2007;98:507-516.

CME Test Questions

1.
Most studies in this review showed a significant intervention effect on which of the following?
- a.
  hospitalizations
- b.
  acute care visits
- c.
  short-acting bronchodilator use
- d.
  asthma symptoms
- e.
  peak flow measurements
2.
Which of the following are feasible methods to provide computerized education for asthma patients?
- a.
  office computer games that provide asthma patients an educational experience during their clinic appointment
- b.
  Web-based educational programs accessible from any Internet-enabled computer
- c.
  clinical vignettes

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Clinicaltrials.gov identifier...

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Citation Excerpt :
With emerging communication technology advances, there are a growing number of avenues through which education can be received by patients and families. A review of various interactive computerized education programs found improved knowledge and symptoms.72,73 Additionally, use of an Internet-based asthma education and monitoring program72 and use of electrical device monitoring combined with structured feedback74,75 were shown to result in improved child adherence.
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The aim of this study was to collect information to design a patient education program (PEP) for patients with systemic lupus erythematosus (SLE), based as much as possible on their expectations.
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The patients who answered the expectation questionnaire (n = 422, women/men sex-ratio: 12.6) indicated a major interest in the PEP (70.4%). Their expectations were broad, and covered the topics of pregnancy (90% of the women under the age of 40), the outcome of the disease (80.8%), the respective roles of the different treatments (70.4%), and also the management of everyday symptoms: fatigue and pain (66.4%). The focus group (eight people) highlighted the need for improving how the diagnosis of the disease was delivered, and also revealed the loneliness and the guilty feeling experienced by some patients toward their relatives. Satisfaction questionnaires confirmed these expectations for the PEP, and even extended them to new topics: the mechanisms behind SLE, travel and leisure, and possible accommodations in the workplace.
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This feature is funded in part by an educational grant from AstraZeneca LP

This study was partially funded through salary support from the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

View full text

CME reviewA systematic review of randomized control trials evaluating the effectiveness of interactive computerized asthma patient education programs

Background

Objective

Data Sources

Study Selection

Results

Conclusions

Section snippets

INTRODUCTION

METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

CME Examination

CME Test Questions

J Allergy Clin Immunol

Respir Med

J Pediatric Health Care

Patient Educ Counseling

Guidelines for the Diagnosis and Management of Asthma, Report 2

Attaining optimal asthma control: a practice parameter update

J Allergy Clin Immunology

The effects of limited (information only) patient education programs on the health outcomes of adults with asthma (Cochrane Review)

The Cochrane Library

Self-management education and regular practitioner review for adults with asthma (Cochrane Review)

The Cochrane Library

Results of a home-based environmental intervention among urban children with asthma

N Engl J Med

Pewet Internet and American Life Project, Internet the Mainstreaming of Online life

CME review
A systematic review of randomized control trials evaluating the effectiveness of interactive computerized asthma patient education programs