Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Valerio, M.A., N.K. Janz, E.A. Parker, C.M. Connell, and Mick P. Couper. 2007. "Women with asthma: Who uses an asthma diary and how helpful is it?" Chest, 132(4): 450S-450S.
PURPOSE: Asthma continues to be a significant problem in adult women. The objective of this study was to identify demographic and clinical characteristics associated with use of an asthma diary and differences in long-term asthma outcomes between women who used the asthma diary and those that did not.
METHODS: Women were part of a randomized controlled trial to evaluate a self-regulatory education program. Demographic and clinical characteristics were examined as predictors of diary use among women in the intervention group (N = 424). Logistic regression was performed to examine diary use by a range of demographic and clinical variables. Hierarchical linear modeling (HLM) was conducted to examine the influence of asthma diary use on health outcomes across time. Demographic and clinical characteristics were included in the models to examine the influence of diary use on asthma outcomes.
RESULTS: Demographic characteristics such as older age (p < 0.05) and higher education (p < 0.05) were predictive of asthma diary use. More severe asthma (p < 0.01) and a history of smoking (p < 0.05) were found to be significant predictors of less initiation of diary use. Neither employment, income, marital status nor co-morbidities were predictors of diary use. Results indicate that women who used the asthma diary had significantly better self-efficacy (p<0.01), less unscheduled physician office visits (p<0.001) and a trend towards better individual levels of self-regulation at follow-up when compared to those that did not. Quality of life in both the women who used the diary and those that did not improved over time.
CONCLUSION: Age, education, asthma severity, and a history of smoking all distinguish individuals who use an asthma diary from those who do not. Use of an asthma diary may increase self-efficacy and lead to better asthma outcomes.
CLINICAL IMPLICATIONS: The actual use and potential benefits of an asthma diary in different groups of patients may be under-explored. Clinicians and researchers should carefully consider recommending use of a diary in asthma management.