Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?

M. R. Partridge, A. L. Caress, C. Brown, J. Hennings, K. Luker, A. Woodcock, M. Campbell

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Design: Randomised equivalence trial. Setting: 39 general practices in West London and North West England. Participants: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. Intervention: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Main outcome measures: Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids. Results: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. Trial registration number: NCT00129987.

Original languageEnglish
Pages (from-to)778-783
Number of pages6
JournalThorax
Volume63
Issue number9
DOIs
Publication statusPublished - 15 Feb 2008
Externally publishedYes

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Self Care
Primary Health Care
Asthma
Nurses
Education
Referral and Consultation
Patient Satisfaction
Steroids
Outcome Assessment (Health Care)
Delivery of Health Care
Telephone
General Practice
England
Tablets
Therapeutics

Cite this

Partridge, M. R. ; Caress, A. L. ; Brown, C. ; Hennings, J. ; Luker, K. ; Woodcock, A. ; Campbell, M. / Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?. In: Thorax. 2008 ; Vol. 63, No. 9. pp. 778-783.
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abstract = "Objectives: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Design: Randomised equivalence trial. Setting: 39 general practices in West London and North West England. Participants: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. Intervention: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Main outcome measures: Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids. Results: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0{\%}) and in 56/171 patients (32.7{\%}) seen by a lay educator. For 418/567 patients (73.7{\%}), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8{\%}) in the nurse led group required unscheduled care compared with 65/213 (30.5{\%}) in the lay led group (90{\%} CI for difference -8.1{\%} to 6.6{\%}; 95{\%} CI for difference -9.5{\%} to 8.0{\%}). The 90{\%} CI contained the predetermined equivalence region (-5{\%} to +5{\%}) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2{\%}) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. Trial registration number: NCT00129987.",
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Partridge, MR, Caress, AL, Brown, C, Hennings, J, Luker, K, Woodcock, A & Campbell, M 2008, 'Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?', Thorax, vol. 63, no. 9, pp. 778-783. https://doi.org/10.1136/thx.2007.084251

Can lay people deliver asthma self-management education as effectively as primary care based practice nurses? / Partridge, M. R.; Caress, A. L.; Brown, C.; Hennings, J.; Luker, K.; Woodcock, A.; Campbell, M.

In: Thorax, Vol. 63, No. 9, 15.02.2008, p. 778-783.

Research output: Contribution to journalArticle

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N2 - Objectives: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Design: Randomised equivalence trial. Setting: 39 general practices in West London and North West England. Participants: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. Intervention: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Main outcome measures: Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids. Results: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. Trial registration number: NCT00129987.

AB - Objectives: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Design: Randomised equivalence trial. Setting: 39 general practices in West London and North West England. Participants: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. Intervention: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Main outcome measures: Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids. Results: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. Trial registration number: NCT00129987.

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