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British Guideline on the MAnAGeMent of AsthMA
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Checklist 1. Suggested content for an educational programme/discussion
This checklist is intended as an example, which health professionals should adapt
to meet the needs of individual patients and/or carers. The purpose of education
is to empower patients and/or carers to undertake self management more
appropriately and effectively. Information given should be tailored to individual
patient’s social, emotional and disease status, and age. Different approaches are
needed for different ages.
Nature of the disease
Nature of the treatment
Identify areas where patient most wants treatment to have effect
How to use the treatment
Development of self monitoring/self assessment skills
Negotiation of the personalised action plan in light of identified patient goals
Recognition and management of acute exacerbations
Appropriate allergen or trigger avoidance.
9.1.2 SELF MANAGEMENT PROGRAMMES IN SPECIFIC PATIENT GROUPS
A range of different patient populations are included in the trials. It cannot be assumed that a
successful intervention in one setting will be feasible or appropriate in another. The greatest
benefits are shown in those managed in secondary care. 682,711,712 Primary care studies have
also shown benefit, 698,700,702,741 though effects are weaker, perhaps because clinical benefit is
harder to demonstrate in people with mild asthma. Innovative approaches to self management
education in teenagers (web-based, peer delivered within schools) appear to have more success
than more traditional programmes. 699-701,706,709,742-744 A different approach may be needed for
pre-school children, many of whom have viral induced wheeze. 683,745,746 There are no studies
which specifically address the provision of self-management education to the elderly. Sub group
analyses from UK trials have suggested that existing self-management programmes may be of
less benefit in ethnic minority groups, but there is a lack of studies evaluating more appropriate
interventions. 698,705
Self management programmes will only achieve better health outcomes if the prescribed asthma
treatment is appropriate and within guideline recommendations. 713,717 There is some evidence
that ownership of a self management plan may attract better treatment (ie increased steroid
provision from attending physicians). 682,698,701
9.2 CoMPliAnCe And ConCordAnCe
The term compliance embodies a traditional model of prescriptive care which refers to the
objectively measured usage of prescribed medication, or frequency of monitoring. Non-
compliance may be intentional or unintentional. The term ‘concordance’ signifies a negotiated
agreement between the professional and the patient. Non-concordance describes an inability
of both parties to come to an understanding, not merely a failure of the patient to follow the
health professional’s instructions. 747 Studies which assess whether or not the patient believes
that their behaviour is appropriate find correlations between beliefs about illness and medicine
and concordance. 748,749 Achieving concordance is likely to improve (though not guarantee)
compliance.