Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. 575-586 (doi:10.1542/peds.2007-0113)
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SPECIAL ARTICLE

Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis

Janet M. Coffman, MPP, PhDa, Michael D. Cabana, MD, MPHa,b, Helen Ann Halpin, PhDc and Edward H. Yelin, PhDa,d

a Institute for Health Policy Studies and Departments of
b Pediatrics, Epidemiology, and Biostatistics
d Medicine, University of California, San Francisco, California
c Center for Health and Public Policy Studies and Department of Community Health and Human Development, University of California, Berkeley, California

OBJECTIVE. National Heart, Lung, and Blood Institute clinical practice guidelines strongly recommend that health professionals educate children with asthma and their caregivers about self-management. We conducted a meta-analysis to estimate the effects of pediatric asthma education on hospitalizations, emergency department visits, and urgent physician visits for asthma.

PATIENTS AND METHODS. Inclusion criteria included enrollment of children aged 2 to 17 years with a clinical diagnosis of asthma who resided in the United States. Pooled standardized mean differences and pooled odds ratios were calculated. Random-effects models were estimated for all outcomes assessed.

RESULTS. Of the 208 studies identified and screened, 37 met the inclusion criteria. Twenty-seven compared educational interventions to usual care, and 10 compared different interventions. Among studies that compared asthma education to usual care, education was associated with statistically significant decreases in mean hospitalizations and mean emergency department visits and a trend toward lower odds of an emergency department visit. Education did not affect the odds of hospitalization or the mean number of urgent physician visits. Findings from studies that compared different types of asthma education interventions suggest that providing more sessions and more opportunities for interactive learning may produce better outcomes.

CONCLUSIONS. Providing pediatric asthma education reduces mean number of hospitalizations and emergency department visits and the odds of an emergency department visit for asthma, but not the odds of hospitalization or mean number of urgent physician visits. Health plans should invest in pediatric asthma education or provide health professionals with incentives to furnish such education. Additional research is needed to determine the most important components of interventions and compare the cost-effectiveness of different interventions.

Key Words: asthma • asthma education • children • patient education • self-management

Abbreviations: NHLBI—National Heart, Lung, and Blood Institute • ED—emergency department • RCT—randomized, controlled trial • SMD—standardized mean difference • CLs—confidence limits • OR—odds ratio

Accepted Aug 20, 2007.