Adults with Asthma
Worksite-Based Asthma Education Program
Burton WN, Schultz AR, Connerty CM, Chen C-Y, Edington DW. Asthma disease management: A worksite-based asthma education program. Disease Management 2001;4:3-13.
Participants’ worksite during lunch break
Employees with nonoccupational asthma working for BankOne in Chicago
Asthma accounts for an estimated 3 million workdays lost each year in the United States and for reduced worker productivity. The objective of this study was to evaluate a relatively low-cost managed care organization, worksite-based, employee education program designed to improve control of asthma in workers. Downtown Chicago BankOne employees were offered the “FirstAirAsthma Education Program” in October, 1998. The benefit to employees was learning the value and importance of optimal management and the elements of self-care. Benefits to the employer included the prospect of increased productivity reflecting a potential reduction in absences from work and impaired work performance, enhanced employee morale, and decreased medical claims. Before entering the program, each participant completed a computerized health-risk appraisal that elicited behavioral and other health information and included measurements of blood pressure, serum cholesterol, and height and weight to calculate body mass index. Employees with asthma were identified through BankOne’s Occupational Medical and Nursing Information database that includes health insurance claims, short-term disability absences, and medical records. An occupational health nurse trained in the program’s objectives and content interviewed each person who had a medical claim associated with asthma and invited him/her them to participate.
The FirstAirAsthma Education Program consisted of five weekly 1-hour sessions conducted during lunch hours. A trained clinical asthma nurse specialist conducted the sessions. Topics included symptoms of asthma; recognition of triggers and warning signs of asthmatic attacks; medications and other treatments for asthma; use and care of peak flow meters, nebulizers, and metered-dose inhalers; handling of emergencies; and ways to keep an asthma diary. Participants were given incentives to encourage completion of the program including a free lunch at every session, a free 1-year subscription to Asthma Magazine, a wellness tote bag filled with educational materials, a copy of the book How to Outsmart Your Allergies, and a drawing for a number of items useful for people with asthma. Participants who completed a health questionnaire focused on asthma were given a $25 gift certificate. The Asthma Therapy Assessment Questionnaire (ATAQ), developed and distributed by Merck & Company, Inc., was used to evaluate the effectiveness of the FirstAir program. The ATAQ measures a person’s self-reported severity of asthma symptoms, medication compliance barriers, deficiency in knowledge of asthma, and barriers to effective communication with his/her health care provider. Participants completed the ATAQ at baseline, at the end of the 2-month program, and 4 and 12 months after the program.
A pre-post test design was used.
Seventy six adults enrolled in the asthma education program.
Poor asthma control was defined by four “control barriers”:
- self-reported missed work or school and impact on normal activity,
- nocturnal asthma symptoms,
- overuse or increase in the use of beta-agonists, and
- self-assessment of asthma control.
These barriers were the study outcome measures. The sum of responses on the ATAQ to these four questions created the control barrier score which ranged from 0 to 4. As a result of the intervention, ATAQ scores significantly improved. The mean score for control barriers showed a positive trend, declining from 1.83 at baseline to 1.28 at 12 months. The number of employees who reported no control barriers increased from 11% at baseline to 28% after 4 months. The number of employees who reported all four control barriers decreased from 7% at baseline to 0% at 4 months and persisted at the 12-month follow-up. The percentage of participants who had prescriptions for controller medication increased significantly from 59% at baseline to 76% at the 12-month follow-up. The number of participants who reported using asthma controller medication on a daily basis also increased significantly.