As a nurse practitioner in a primary health care practice, you see many adult patients with asthma. The primary health care team wants to discuss strategies to improve care for these patients. You offer to search the literature on the topic and report back at the next team meeting.
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1. How and where would you look for evidence to decide what to do?
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Correct answer:
You pose the question, "Is a self-management programme that includes asthma education plus regular review by health professionals, effective in improving health outcomes for adults with asthma?"
Using "asthma" OR "wheeze" AND "patient education" as search terms, you might look first in the Cochrane Library as this is a medical area for which they might be a systematic review. This simple search would identify the following review:
Gibson PG, Coughlan J, Wilson AJ, et al. Self-management education and regular practitioner review for adults with asthma (Cochrane Review, latest update 29 May 2002).
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2. Would this review help decision-making?
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Correct answer:
The review includes 24 RCTs and covers self-management education that included a written action plan, self-monitoring, and regular medical review. The review concludes that these studies show that self management led to a reduction in the proportion of patients reporting hospitalizations and emergency department visits for asthma, unscheduled doctor visits for asthma, days lost from work because of asthma, and episodes of nocturnal asthma.
The review is quite dated but is likely to be transferable evidence to most populations.
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3. What questions might this search for evidence NOT answer?
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Correct answer:
Self-management is an established and effective approach to controlling asthma and is recommended in British clinical national guidelines on the management of asthma. Evidence reviews, however, may only report on effectiveness and not explain the low uptake and use of self-management among people with asthma, parents/caregivers of children with asthma, and their promotion by health professionals.
