Outcomes of a Web-Based Patient Education Program for Asthmatic Children and Adolescents: Research

Table 4 shows major characteristics of the PPP and the group of noncompleters at baseline assessment. Patients who did not complete the study tended to use more health-care resources. Among the patients who were assigned to the intervention groups, study completers had significantly lower morbidity costs at baseline when compared to noncompleters.
The medical outcomes of the PPP are summarized in Table 5. Various improvements were reported in all study groups, but patients using the IEP were the only ones to experience a statistically significant short-term reduction in asthma-related emergencies and a long-term decrease in the daily use of rescue medication. During the follow-up year, morbidity costs savings in the IEP group were due to a reduction in physician consultations (56%), asthma-related emergency treatments (75%), and daily medication costs (52%) [Fig 2].
Compared to the year prior to baseline, average morbidity cost savings during the first year after intervention made up 461€ from a health insurance perspective and 467€ from a societal perspective in the IEP group. Patients in the IEP group had significant reductions (p < 0.05) in both days off school (— 75%) and average daily use of rescue medications (— 77%) when comparing visit 2 data with baseline. canadian neighbor pharmacy com

In the CG, significant improvements (p < 0.05) were observed when analyzing the number of outpatient visits (— 6%) and the number of lost school days (— 35%) before and after the trial initiation. Benefits in the usual care group reached 1.55€ from a paymaster perspective and 58€ from a societal perspective. Patients receiving the SPMP alone had better outcomes than control subjects, eg, significantly (p < 0.05) less physician consultations (— 44%), emergency treatments (— 67%), and days off school ( — 71%) in the follow-up period.
In contrast to the IEP group, the reduction in the average daily use of rescue medication among SPMP patients did not reach a statistically significant level. Compared to the IEP group, it took longer to realize a statistically significant reduction in the number of emergencies. Morbidity cost savings in the traditional patient education group (SPMP) were lower when compared to IEP group patients and added up to 301€ from a paymaster perspective and 333€ from a societal perspective. Adjusted benefit, net benefit, and benefit-cost-ratio applicable to the two intervention groups are summarized in Table 6.

Table 4—Comparison of Study Completers and Dropouts

Variables Completers (n = 178) Noncompleters (n = 180) p Value
Degree of asthma severity at baseline assessment 0.93
Mild intermittent 22 (12.4) 28(15.6)
Mild persistent 68 (38.2) 47 (26.1)
Moderate persistent 82 (46.1) 62 (34.4)
Severe persistent 3(1.7) 10 (5.6)
Missing information 3(1.7) 33 (18.3)
Female sex 64 (36.0) 69 (38.3) 0.47
Six months prior to baseline
Referrals to hospital, No. 0.06 ± 0.30 0.13 ± 0.50 0.11
Inpatient days, No. 0.13 ± 0.84 0.67 ± 3.01 0.15
School absenteeism, d 2.01 ± 4.29 3.86 ± 11.65 0.33
Daily drug therapy costs, € 1.45 ± 1.22 1.75 ± 1.61 0.10
Consultations, No. 3.84 ± 4.19 4.32 ± 4.86 0.81
Average daily use of reliever medication 0.28 ± 0.73 0.35 ± 1.02 0.60
At baseline assessment
Total QoL as measured with the KINDL questionnaire 75.5 ± 11.78 76.1 ± 12.17 0.47
Intervention groups (n = 273)
Average total costs at baseline, € 527.78 ± 398.19 (n = 130) 669.00 ± 648.26 (n = 143) 0.007

Table 5—Medical Resource-Use Data, Use of Rescue Medication, and School Absenteeism in the Observation Period

Program CG (n = 48) SPMP (n = 86) SPMP Plus IEP (n = 44) p Value, Kruskal-Wallis p Value, Mann-Whitney
Median Mean* p Value(T1 vs TO, Wilcoxon) Median Mean* Ip Value (T1/T2 vs TO, Wilcoxon) Median Mean* p Value (T1/T2 vs TO, Wilcoxon)
Baseline visit (6 mo prior to study entry)
Physician consultations. No. 2 3.5 3 3.4 4 5.2 0.11
Hospital days. No. 0 0.3 0 0.1 0 0.1 0.16
Emergencies, No. 0 0.4 0 0.6 0 0.4 0.99
Working days lost (caregivers). No. 0 0.51 0 0.65 0 0.25 0.23
Daily therapy costs, € 0.78 1.27 0.77 1,70 1.73 1.98 0.25
Daily use of rescue medication. No. 0 0.20 0.03 0.23 0 0.26 0.16
Days absent from school. No. 0 2.0 0 3.4 1,5 4.0 0.78
Visit 1 (0 to 6 mo after enrollment)
Physician consultations. No. 1 3.3 0.04 1,5 2.3 0.01 2 2.7 0.02 0.49
Hospital days. No. 0 0 0.18 0 0.3 0.95 0 0.2 0.93 0.43
Emergencies, No. 0 0.2 0.53 0 0.3 0.26 0 0 0.02 0.04 0.03 (IEP vs SPMP)
Working days lost (caregivers). No. 0 1.07 0.07 0 0,56 0.67 0 0.14 0.38 0.77
Therapy costs, € 0.73 1.37 0.88 0.68 1.09 0.07 1,55 1,57 0.19 0.13
Daily use of rescue medication. No. 0 0.12 0.35 0 0.21 0.14 0 0.10 0.18 0.10
Days absent from school. No. 0 1.3 0.05 0 1.7 0.01 0 1.3 0.004 0.01 0.01 (CG vs SPMP)
Visit 2 (6 to 12 mo after enrollment)
Physician consultations. No. 1 1.9 0.00 1 2.3 0.002 0.63
Hospital days. No. 0 0 0.07 0 0 0,56 0.22
Emergencies, No. 0 0.2 0.01 0 0.1 0.03 0.68
Working days lost (caregivers). No. 0 0.17 0.89 0 0.25 0.31 0.93
Daily therapy costs, € 0.41 0.97 0.03 0.49 0.93 0.01 0.15
Daily use of rescue medication. No. 0 0.21 0.13 0 0.06 0.02 0.25
Days absent from school. No. 0 1.0 0.001 0 1.0 0.001 0.14

Table 6—Results of the Cost-Benefit Analysis

Variables CG (n = 48) SPMP (n = 86) SPMP Plus IEP (n = 44)
Intervention cost 541.14 585.13
Cost savings
Paymaster perspective 1.55 300.78 461.45
Societal perspective 57.50 333.20 467.05
Adjusted benefit
Paymaster perspective 299.23 459.90
Societal perspective 275.70 409.55
Net benefit
Paymaster perspective — 241.91 — 125,23
Societal perspective — 218.20 — 118.08
Benefit-cost ratio
Paymaster perspective 0.55 0.79
Societal perspective 0.51 0.70
Subgroup analysis
Adjusted benefit (paymaster perspective)
Moderate or severe asthma 0(n = 19) 579.02 (n = 38) 830.88 (n = 29)
Any emergency 6 mo prior to study entry 0 (n = 12) 600.67 (n = 31) 708.00 (n = 14)
ITT population 0 (n = 85) 183.99 (n = 127) 245.75 (n = 146)
Benefit-cost ratio (paymaster perspective)
Moderate or severe asthma 1.07 1.42
Any emergency 6 mo prior to study entry 1.11 1.21
ITT population 0.34 0.42
Univariate sensitivity analysis
Benefit-cost ratio (paymaster perspective)
50% reduction in SPMP program costs 0.98 1.28
IEP costs twofold higher
Entire population 0.64
Patients with moderate or severe asthma 1.22
25% reduction in drug adherence
Entire population 0.35 0.51
Patients with moderate or severe asthma 1.13 0.86
Elevation of GP reimbursement on specialist level 0.52 0.68

 

Figure-2

Figure 2. Cost development during the observation period. Results are shown as average costs per patient and 6-month period. T0 = baseline; T1 = visit 2; T2 = visit 3.

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