JOURNAL OF ADVANCED NURSING

REVIEW SUMMARIES: EVIDENCE FOR NURSING PRACTICE

Prepared by

Summaries of systematic reviews on nursing-related issues from the Cochrane Library, Joanna Briggs Institute and other evidence review organizations
admissions could be prevented if individuals with asthma were able use an asthma action plan, improved their knowledge of asthma, adhered to preventive treatment, initiated medication early during an asthma attack, and sought medical assistance early if their condition was not improving.

Title Education interventions for adults who attend the emergency room for acute asthma. Reference
Tapp S., Lasserson T.J. & Rowe B.H. (2007) Education interventions for adults who attend the emergency room for acute asthma. Cochrane Database Systematic Reviews Issue 3, Art. No: CD003000. DOI: 10.1002/14651858. CD003000.pub2. Date of most recent substantive amendment: 25 April 2007. The full review report, including references, can be accessed using the digital object identier, DOI: 10.1002/14651858. CD003000.pub2.

Characteristics of evidence
Twelve randomized controlled trials involving 1954 adults met the inclusion criteria. The methodological quality of the studies varied: ve studies were judged to have adequate allocation concealment but the remainder of reports were unclear on the methods of allocation concealment used in the study. Meta-analysis was performed where possible. The results of six studies showed that there was a statistically and clinically signicant decrease in subsequent hospital admissions in the education intervention group. The results of seven studies indicated that there was no statistically signicant reduction between the education and control groups in the numbers re-attending the emergency department. In two studies, the implementation of educational interventions increased the likelihood that patients would schedule an out-patient follow-up appointment. There was a statistically signicantly lower cost of emergency department visits per person per year associated with the educational interventions. In one study statistically signicantly more patients had adequate inhalation techniques and were aware of their peak ow reading in the education group when compared to the control group. No statistically signicant differences were found between the intervention and control groups for the following outcomes: lung function, quality of life, days lost from school/ work, functional impairment, number of participants experiencing symptoms and loss to follow up.

Review question
What is the best available evidence regarding the effectiveness of education given to adults while attending the emergency department for asthma exacerbation therapy in improving health outcomes?

Type of review
Cochrane review containing a meta-analysis of trials.

Relevance for nursing

People with asthma frequently attend emergency departments, and severe asthma attacks can lead to hospitalization. The frequency of these attendances for acute asthma has lead to research investigating the use of nonpharmacological interventions to reduce the future use of health care. There is some evidence that a number of hospital

2008 The Author. Journal compilation 2008 Blackwell Publishing Ltd

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Review Summaries

Implications for nursing

Educational interventions produce statistically signicant improvements in the number of hospital admissions and repeat attendances at emergency departments however, there has been a lack of signicant ndings in relation to other important markers of asthma morbidity and therefore the true effectiveness of these interventions in improving health outcomes remains unknown.

The intensity of the intervention and how this may affect uptake of education. The impact of socio-economic status on access to and continuation of the intervention. The cost-effectiveness of educational interventions. Keywords: acute asthma, asthma education, Cochrane review CARUANA E. (2008) Tapp S., Lasserson T.J., & Rowe B.H. (2007) Education interventions for adults who attend the emergency room for acute asthma. Journal of Advanced Nursing 62(6), 655656. This summary was prepared by Emily Caruana BHSc BSSc Joanna Briggs Institute Adelaide, South Australia e-mail: jbi@adelaide.edu.au

Implications for research

The report recommends: Further high quality and well-reported studies are needed to assess the following: The effect of educational interventions on symptoms, lung function and quality of life.

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2008 The Author. Journal compilation 2008 Blackwell Publishing Ltd