Recorded presentation

David M. Mosen, PhD, MPH, Care Management Institute, Kaiser Permanente, 500 NE Multnomah St, Suite 240, Portland, OR 97232, 503-813-3827, david.mosen@kp.org

Objective: Knowledge of self-management practices is important to effectively manage chronic conditions. However, few studies have examined the impact of such knowledge on health-related outcomes.. We examined the relationship of knowledge of asthma self-management practices on the following outcomes: frequent short-acting beta agonist (SABA) use, inhaled anti-inflammatory (IAI) use, asthma-related ED utilization, and asthma-related hospital admissions.

Methods: We examined survey and administrative data for 2,021 adult persistent asthmatics enrolled in a large staff model HMO located in the western United States. Persistent asthmatics were identified during calendar year 1999 using HEDIS inclusion criteria. In Fall 2000, the same patients were surveyed (via mail/telephone) regarding their knowledge of asthma self-management behaviors using a valid and reliable instrument developed by the Foundation for Accountability (FACCT). A 0-100 composite score was constructed, with zero representing the lowest self-management knowledge and 100 representing the highest. The measure was dichotomized into low knowledge (0-50) and high knowledge (51-100). Medication and resource utilization data were measured via an electronic medical record during calendar year 2001.

Multiple logistic regression was used to evaluate the independent effect of knowledge of self-management behaviors (high knowledge vs knowledge) on frequent SABA use, IAI use, and resource utilization; adjusting for the following variables: age, gender, race/ethnicity, income, years of education, smoking status, and asthma severity.

Results: After adjusting for demographic factors, smoking status, and asthma severity, adults with high knowledge of self-management practices were more likely to use IAI medications (O.R. 1.6 95% CI = 1.2 – 2.2), compared to adults with low knowledge of self-management practices. Higher knowledge of self-management practices was not associated with frequent SABA use, ED utilization, or hospital admissions.

Conclusions: We found that higher knowledge of self-management practices is independently associated with higher inhaled anti-inflammatory use, the recommended first-line therapy for long-term asthma control. However, higher knowledge of self-management practices could not be shown to reduce adverse events, such as hospital admissions or ED utilization. The reasons for this negative finding could include insensitivity of the FACCT instrument and/or ED and hospital utilization as outcome measures. Future research is necessary to clarify these issues.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Understand the importance of asthma self-management practices for adults with persistent asthma
• Determine whether higher knowledge of asthma self-management practices are associated with improved outcomes of care
• Identify alternate, sensitive measures to evaluate the impact of knowledge of asthma self-management practices

Keywords: Self-Management, Outcomes Research

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation