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Editor,—Wesseldine and colleagues showed a significant decrease in asthma readmission rates in children whose parents received 20 minutes of structured asthma education before their child was discharged from hospital.1
In October 1992, a community based, nurse-led, children’s asthma service was established in Central Manchester, UK with the aim of informing and empowering asthmatic children and their parents to undertake day to day management of asthma through a structured education programme.2 Over a third of the educational encounters take place in the patient’s home. Parents and teenagers have direct access to asthma nurse specialists by telephone during working hours and to the weekly asthma education drop-in clinic.3
All children admitted to our inner city general paediatric unit with acute asthma are routinely referred to asthma nurse specialists. We undertook a retrospective case note audit to test the hypothesis that this structured nurse-led education programme would lead to a reduction in the hospital readmission rates for acute asthma. Hospital admission and readmission rates of all patients with acute asthma between the ages of 2 and 15 years were compared during 24 month periods before (January 1990 to December 1991) and after (January 1994 to December 1995) establishment of the nurse-led asthma education service (table1). Over 90% of patients and their parents were seen within a week of discharge from hospital and each educational session lasted around 20 minutes.
We accept the limitations of using a retrospective case note audit; nevertheless, given the intensity of the educational input provided in the community and in the patient’s home, we were disappointed to observe a small increase in the rate of readmission of children with asthma in the “posteducation” period. The relatively deprived population that we serve (the average Jarman score of families studied was 44), cultural beliefs of some of our patients about asthma, and the content and timing of the education programme might have contributed to the failure of our service in reducing hospital readmissions. Results of the study by Wesseldine and colleagues1 and our audit suggest that the delivery of an asthma education programme to the captive population in hospital rather than after discharge may be more effective in preventing readmissions. If these findings are confirmed by further studies, it poses an important challenge in the delivery of a predischarge asthma education programme in the setting of short stay or ambulatory paediatric units, which are increasingly being proposed as models of care for all but very ill children.
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