P1247676904eMrXc

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Johns Hopkins Asthma Allergy Center
Healthcare SCORM Showcase Asthma Education,
Adherence and Health Beliefs Tao Le, MDResearch
Fellow, Division of Clinical Allergy and
ImmunologyJohns Hopkins University School of
MedicineCo-founder, Medsn, Inc. May 10, 2004
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Disclosures and Funding

• Co-founder and consultant to Medsn
• Minority equity stake in Medsn managed by Johns
  Hopkins University Office of Policy Coordination
• Some research presented funded by
• NHLBI 5R01HL073494-02
• NHLBI 5R01HL064200-03
• NHLBI 5R01HL064199-03

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Acknowledgments

• Johns Hopkins
• Cynthia Rand, PhD
• Susan Bartlett, PhD
• Robert Wise, MD
• Andrew Bilderback
• Jerry Krishnan, MD
• Peter Creticos, MD
• Ed Horowitz
• American Lung Association-Asthma Clinical
  Research Centers

• Medsn
• Tarun Mathur
• Richard Currier, PhD
• Prashant Rao
• Ian Williams
• Allen Levinson
• Dennis Bonilla

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The Asthma Burden in America

• 2001National Health Interview Survey
• 31.3 MM Americans dx with asthma during lifetime
• 20.3 MM currently have asthma
• 12 MM had at least one asthma exacerbation
• 2002 direct and indirect costs 14B

American Lung Association, 2003
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Education as An Intervention

• A key component of most asthma guidelines
• NAEPP Expert Panel Report 2002 Update
• International Consensus Report on Diagnosis and
  Treatment of Asthma 1992

JACI 2002110(5)S183-S195
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Asthma Education for Self-Management

• Cochrane meta-analysis of 36 trials involving
  6090 participants
• Education about asthma and self-management with
  regular health provider review led to
• ? emergency department visits
• ? hospitalizations
• ? lost days of work
• ? QOL

Gibson, Cochrane Library, Issue 2, 2003
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Barriers to Education

• Survey of pulmonary training programs
• 64 had formal patient education programs
• 72 were at university programs
• Reasons for not having a program
• Too expensive
• Too time consuming
• Lack of reimbursement

Peterson, J Asthma. 200138261-267
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Potential Advantages of Interactive Multimedia
(IMM)

• Free up personnel resources
• Low incremental costs
• Delivers standardized, yet tailored education
• Can be updated via a network
• Can be integrated into clinic visits
• Equivalent or superior re knowledge transfer vs.
  other formats

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IMM Patient Education

• One 20 minute module
• Social-cognitive learning theory
• Self-efficacy, symbolic learning, vicarious
  learning, goal setting, value setting, time to
  results, motivation, role modeling, symbolic
  associations, personalization and social
  persuasion, feedback
• Activity-based learning
• Problem solving and discovery learning

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IMM Patient Education
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An Education Paradigm
Education
Knowledge
Behavior
Health Outcomes
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SCORM Issues

• Compliant with SCORM 1.2
• Follow content aggregation book
• Content packaging metadata
• SCOs
• Course
• Modules
• Frames
• Quizzes and interactivities at the end of a
  module

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Impact of Expectations and Beliefs on Adherence

• 31 adults with asthma on daily inhaled steroids
  therapy enrolled in the AIRS adherence trial
• Collected baseline data on inhaled steroids
  expectations and beliefs
• Adherence x 1 mo prospectively measured with
  MDIlogs

Le et al., unpublished data
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Impact of Expectations and Beliefs on Adherence
with ICS treatment
Le et al., unpublished data
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Study Design

• 20 min
• 7th grade level

• Health Literacy
• Asthma Control
• Asthma QOL
• Asthma Knowledge
• Asthma Beliefs
• Outcomes Expectancy

50 Asthma Patients
RANDOMIZE

• JHAAC
• Allergy Pulmonary

• 4 pg, color illus.
• Equiv. content

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Tao Le, MD tao_at_jhmi.edu tao.le_at_medsn.com