MedWire News: Trained lay educators are as likely to recommend meaningful changes to asthma management as nurses, and garner the same level of patient satisfaction, according to a UK study.
The findings have particular relevance as UK national guideline recommendations promote self-management education for asthmatics, but evidence suggests that this aspect of the guidelines is poorly implemented, Martyn Partridge (Imperial College London) and colleagues explain in the journal Thorax.
Most asthmatics have limited contact with healthcare professionals, so it is important that they self manage their disease, by recognizing deteriorating symptoms, adjusting therapy, and knowing when to seek medical attention.
However, evidence suggests that self-management education is poorly implemented, and alternatives to health professional delivery of patient education programs need to be explored.
Partridge and colleagues therefore designed a randomized equivalence trial to investigate whether appropriately trained lay people can give self-management education to adults with asthma, and whether the outcomes are equivalent to those achieved by nurse-led education.
A total of 567 asthmatic patients were randomly assigned to receive an initial consultation for up to 45 minutes from either a lay educator or a practice-based primary care nurse, followed by a second 30 minute face-to-face consultation 3 weeks later and telephone follow-up every 3 months for 1 year.
During the first two consultations, management changes were made in 24.0% of patients seen by a practice nurse and 32.7% of patients seen by a lay educator, a nonsignificant difference. There was also no difference in healthcare use between the two groups at the 1-year follow-up, with 29.8% of patients in the nurse-led group requiring unscheduled care compared with 30.5% of those in the lay-led group.
Furthermore, nurses and lay educators achieved almost identical average patient satisfaction scores, the authors report.
Partridge and colleagues conclude: "We have demonstrated that such education can be given by well-trained lay persons, with outcomes comparable to those achieved by practice nurses."
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