Patient self management and hospital admission in acute asthma
This study describes self management behaviour and attitudes among asthmatics, in usual self care, in acute episodes and in behaviour in the month before admission. It relates these behaviours to morbidity, admission history (single admittees versus multiple admittees) and outpatient status (current, discharged or never outpatient). Two hundred and thirty four patients between 16 and 65 years old were interviewed for the study. One hundred and thirty were in hospital at interview, the remainder were not in hospital but had all had a hospital admission between January and December 1987. Details of admissions in the following twelve months were collected for the hospitalised interviewees. In both hospitalised and non hospitalised groups self management was related to being in current specialist care, rather than to admission history. Patients in current specialist care were more compliant and acted at earlier stages of deterioration. When care type was controlled for, patients with multiple admissions were more non compliant with regular medication, and non compliant patients had significantly more frequent episodes. Forty (30%) of the hospitalised group were readmitted within 12 months of interview. Readmission was not related to self management before the 1991 admission or asthma attitudes. It is argued that this is because patients are likely to be referred to specialist care after an admission (almost 50% of first admissions and almost 100% of second admissions) and that this referral will change both their medical management and their self management. Hence, pre admission behaviour and attitudes cannot predict post admission risk. The study concludes that patient behaviour is most strongly influenced by being in specialist care, and that differences in self management, particularly compliance with prophylaxis and early action in deterioration, affect the risk of severe episodes and hospital admission.