- Volume 8 | Winter 2012
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Patients Should Demand Asthma Action Plans
Asking Dr. Stuart Stoloff about asthma action plans (AAPs) is like asking Eli Manning, quarterback for the New York Giants, about football: He's at the top of his game, and passionate about it. With asthma, trying to maintain control without an asthma action plan is like asking football players to go out on the field without a game plan.
"An AAP is just one spoke in the wheel, a component in a greater, open dialogue between clinician and patient," said Stoloff, M.D., a clinical professor in the Department of Family and Community Medicine at the University of Nevada School of Medicine, and a family medicine practitioner. He also served as a member of the National Asthma Education and Prevention Program's Expert Panel II and III Guidelines for the Diagnosis and Management of Asthma.
Dr. Stoloff is talking about a partnership where the patient, and/or patient's family, actively works with the healthcare provider to learn about asthma, how to identify asthma triggers and symptoms, and ways to address them (including how to administer medication correctly.)
Developing individualized written AAPs, and educating patients on their use, is the foundation for this partnership since it removes the guesswork from treating asthma, and improves patient outcomes. That's why the National Asthma Education and Prevention Program's (NAEPP) clinical practice guidelines encourage patients and their health professionals to establish and maintain a partnership for asthma care.
LeRoy M. Graham, M.D.—a pediatric pulmonologist in Atlanta who sees a diverse array of patients at his practice—agrees.
GIP in Focus
Patient Engagement = The Key to Easier Breathing
When Dr. James Li speaks of engagement, he's not talking about someone getting down on bent knee, ring in hand.
"Patients need to engage with their clinicians in order for an asthma action plan to be effective," said Li, M.D., Ph.D., an asthma and allergy specialist and chair of the Division of Allergic Diseases in the Mayo Clinic's Department of Internal Medicine. "Just having the piece of paper alone—without having the skills or knowledge to understand it—does not improve the care and control of asthma."
When it comes to developing asthma action plans, the National Asthma Education and Prevention Program's (NAEPP) clinical practice guidelines recommend that clinicians involve patients and caregivers in making decisions about treatment, and provide tools and materials to help educate and empower them to understand and follow the plan. In other words, the guidelines emphasize shared decision-making.
"The goal or goals should be excellent asthma care and control, including being able to recognize and treat exacerbations," said Li. "The danger is in making the AAP a goal in and of itself."
Asthma Research into Action
A Single Word Can Make a World of Difference
“The difference between the almost right word and the right word is really a large matter—'tis the difference between the lightning-bug and the lightning.”—Mark Twain
Michelle M. Cloutier, M.D., a pediatric pulmonologist at the Asthma Center of the Connecticut Children's Medical Center in Hartford—where novelist Mark Twain once lived—knows firsthand the importance of choosing the right words when creating asthma materials for patients. That is why she and her team field-test their asthma messages, to ensure that patients and families are interpreting them as intended.
As she found out, while testing a draft version of an asthma action plan (AAP), interpretation sometimes hinges upon a single word.
"When we asked our families what an asthma action plan is, they responded that it was a legal document—a document that you use to take legal action against your doctor," said Cloutier. "It was the word 'action' that led to that interpretation."
That's why the Asthma Center now refers to its asthma action plans as asthma treatment plans, instead, and has seen great success with the change.
"What has happened is that repetition of the word 'treatment'—with which patients and families are familiar because it's already used in clinical settings—drives home the point of the plan," said Cloutier.
Trading out one word for another is not the only change that Cloutier’s team made to the Asthma Center’s Asthma Treatment Plan.
Asthma Action Plan Changes Lead to Nearly 100% Usage
The northern half of the New York City borough of Brooklyn is one of the most diverse areas of the nation, serving as home to many immigrant and working-class communities including large Latino, Polish, and Hasidic Jewish populations.
It’s also home to the Woodhull Medical Center (“Woodhull”), one of 11 hospitals in the New York City Health and Hospitals Corporation (HHC) network, and one of 13 National Asthma Control Initiative (NACI) Demonstration Projects.
As a result of its location, Woodhull has tailored many of its asthma materials to fit the language, culture, and other needs of this array of patients.
Equally important, Woodhull has adapted its asthma resources to fit the practical needs of the busy clinicians who serve these patients. An update to Woodhull’s existing asthma action plan (AAP), which is embedded in an electronic medical records system, yielded some of the greatest improvements.
"We began modifying our asthma action plan in 2009, after we saw that it was not being universally used by providers," said Michael J. Akerman, M.D., a pulmonologist, Medical Director of Woodhull's Asthma Program, and the lead investigator on the NACI Physician Asthma Care Education and Reinforcement (PACER) demonstration project. "Since we made our changes, it's gone from less-than-optimal usage to nearly universal usage by clinicians."
What did Woodhull change?