ABSTRACT
TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Asthma is a common illness affecting 8% of the US population and costing $81.9 billion per year. Due to its chronic and variable nature, asthmatics need frequent medication adjustments, making management challenging for both physicians and patients. Patients can control their asthma with an asthma action plan (AAP), which has directions for daily assessment, medications, and steps to detect and treat exacerbations. Self-management using AAPs is associated with a reduction in hospital admissions and ED visits by 40% and 20%, respectively. Despite evidence that AAPs are efficacious, the exact reason for their success is not known. We hypothesized that AAPs increase patient confidence managing asthma and that this is a reason for AAPs success. Our study explored whether AAP use increases confidence in self-management and asthma control. METHODS: Patients with a physician diagnosis of asthma were recruited. An eight-question Likert Scale survey developed prior gauged confidence about asthma management. At the initial visit, each patient completed the survey, received a personalized AAP, and was taught to use a peak flow meter. The same survey was given at a follow-up scheduled at the provider’s discretion. Asthma control was assessed pre and post-AAP use with the Asthma Control Test (ACT), a validated measure of asthma control. An ACT score of ≥ 19 indicates good control. All data was collected using REDCap. Results were calculated using the student t-test. RESULTS: We recruited 71 patients, and 17 were excluded for lack of follow-up. Post-AAP use, confidence using a peak flow meter increased by 45%, with 93% (50/54) rating confidence at ≥ 3 (4 being ‘strongly agree I am confident’). Fifteen percent more patients felt confident managing exacerbations, with 95% (51/54) rating confidence at ≥ 3. A 15% increase was seen in knowing asthma triggers, with 89% (48/54) rating confidence at ≥ 3. Confidence understanding medications was not impacted by AAPs, with 94% (51/54) of patients rating confidence at ≥ 3 pre and post-AAP use. Mean pre and post-AAP survey scores were 23.28 and 25.89, respectively. AAP use was associated with significantly higher mean survey scores (25.89±4.16, p =.0001). ACT data was available for 87% (47/54) of patients and 68% (32/47) scored a ≥ 19 on the follow-up ACT. Mean pre and post-AAP scores were 18.49 and 20.11, respectively. AAP use was associated with significantly higher mean ACT scores (20.11±3.35, p =.0043). CONCLUSIONS: This is the first study that shows AAP use increases patient confidence in asthma management. All but one survey question gauged at measuring increased confidence improved post-AAP use. Understanding of asthma medications likely did not see improved confidence due to a lack of discussion about this during AAP education at the initial visit. AAP use resulted in an improved mean ACT score. It is unclear if this is due to AAP use or changes made in medications. Limitations include the variable time interval for follow-up and the lack of ongoing assessment to account for the variable nature of asthma control. CLINICAL IMPLICATIONS: With an increasing reliance on telemedicine during the COVID-19 pandemic, the importance of self-management has been brought to the forefront. AAPs are a simple and effective tool that help physicians hand control over care to their patients. The routine use of AAPs can revolutionize how providers approach asthma management and reduce asthma morbidity. DISCLOSURES: No relevant relationships by Pankhuri Jha, source=Web Response No relevant relationships by Jessica Most, source=Web Response