Psychosocial Barriers to Asthma Education: Physician and Asthma-Educator
It is important that the physician understands that the typical primary care consultation, which is often limited by the high volume of patients that need to be seen, is not the best forum for the delivery of asthma education. In this setting, the physician will often talk in a hurried fashion using technical language that the patient is unlikely to understand. The patient may fail to ask specific questions that will address his or her concerns. This interaction may also be hampered by physician ignorance of optimal asthma management techniques or the benefits of patient education. ventolin inhaler
In recent years, a number of consensus statements and guidelines for asthma education have been developed. The poor methods used in their development and the limited involvement of primary care physicians in their creation has been highlighted. In general, these guidelines have been developed by university-based specialists who see a skewed population of patients. The use of guidelines as a basis for changing patterns of practice raises concerns about physician acceptance, the medico-legal misuse of such guidelines and the abandonment of the art of medicine and accumulated clinical experience in favor of cookbook algorithms.
An Australian study has highlighted some of these difficulties. Bauman and colleagues surveyed 193 family physicians to assess the level of acceptance of a proposed community-based asthma education program. The rationale for the study was an earlier report showing physician resistance to such an intervention. In the Australian study, the survey was carried out among a group of physicians who had attended asthma-related continuing medical education (CME) events compared with a control group.
Overall, only 43% of physicians measured lung function, although when both groups were compared, the CME attenders were more likely to do so. When physicians were asked about the possible impact of a patient asthma program on their practices, non-CME attenders thought that increased patient responsibility for asthma could be dangerous (p<0.05), educated patients would require longer consultations (p<0.05), and that educated patients would consult less often (p<0.02).
These data indicate that a successful asthma education program will require both patient and physician components. This education must include not only prescribing and assessment information but also must establish the therapeutic benefit of patient education in its own right. As if to emphasize this fact, there was no difference in asthma knowledge between attenders and nonattenders.
To overcome these barriers, a specialized nonphysician educator, in most instances a nurse, will be able to deliver a structured program over time. In fee-per-item billing, funding such a program may be difficult. To ensure appropriate standards, a structured program for asthma educators with certification should ensure that programs can be evaluated across regions and that the relative contribution of different barriers discussed can be assessed. Elsewhere in this supplement, the experience of others in the education of asthma educators is outlined.
In conclusion, successful implementation of asthma education involves an awareness of important psychosocial barriers that may arise. Overcoming these barriers is essential to ensure optimal asthma control.