Asthma best managed by education and consultation
EMBARGOED UNTIL 12.00 NOON SUNDAY 18 MAY 2003
Patient-controlled asthma action plans are not a substitute for regular, detailed doctor review and comprehensive education of patients with asthma, according to an article published in the most recent edition of the Medical Journal of Australia.
The editorial, co-authored by University of Tasmania Professor of Medicine, Haydn Walters, noted that there is not consistent evidence that written plans, of themselves, have any effect on asthma control.
The written action plan is a set of rules to alter therapy based on peak expiratory flow monitoring or symptom levels. Providing individualised written asthma patient plans is a major part of the Australian Asthma Management Plan, and the findings are a concern only one year into the Federal Government's national initiative for asthma management.
It also comes at a time when ownership of written action plans appears to be falling across the nation.
Professor Walters noted that patients using action plans have been shown to modify them according to their own perceptions and experience of asthma.
"Self-management programs involving a written action plan were more effective than those that did not, but regular doctor review seemed to be most important," he said.
Data suggest that it is the 'process', and not the written action plan itself that is at fault.
Professor Walters says in light of the findings the role of doctors is crucial - their degree of empathy with patients and the amount of time they give to management issues have significant outcome effects on asthma.
But complicating delivery of asthma care is the poor training of doctors in creating or delivering care packages that incorporate negotiated action plans.
"The uptake of asthma action plans in Australia is disappointing, given that they can be useful as part of the right package," he added.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Professor E Haydn Walters, 0419 770 086 haydn.walters@utas.edu.au
Judith Tokley, AMA, 0408 824 306