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Learning in the Waiting Room

Asthma Education in the Waiting Room
Thomas F. Plaut, M.D. Asthma Consultants, Amherst MA

INTRODUCTION
Health professionals say that their busy schedules allow little time for teaching.
To deal with this problem we asked patients to read about asthma in the waiting room.
We wanted to determine whether they could learn some basic asthma information while waiting to be seen. This process would require no staff time and would reduce complaints about long waits.

METHOD
Sixty-eight allergists, pediatricians and respiratory therapists with an interest in asthma education were invited to participate. Twenty agreed to do so and eight completed the project. In each site the receptionist identified two subjects and controls as they arrived for their first asthma visit to the practice. Three fourths of the subjects and controls had received asthma care elsewhere before this visit.

The receptionist gave a copy of the booklet One Minute Asthma, the only booklet for patients referenced in the 1997 NHLBI Guidelines, to each of the subjects. A slip clipped to the booklet instructed patients to read four specific pages on asthma control, the airways and asthma medicines while they waited to be seen. Many patients read about additional subjects.

In the exam room the physician or respiratory therapist asked three questions of the two subjects and two controls. They forwarded the answers and comments on the One Minute Asthma booklet to me. They also assessed their communication with the subjects and noted whether the reading had led to better questions or a more focused visit.

QUESTIONS
The questions and rationale for each were:

  • Once your asthma is under control, will you be able to run as long as hard as you want?
    Many patients do not understand that they will be able to engage in vigorous physical activity when their asthma is well controlled
  • During an asthma episode does the lining of your airways swell due to inflammation?
    Patients must know that inflammation is the most important component of the asthma process.
  • What are the two main types of asthma medicines?
    The answer to this question is controller and quick relief. Individual medicine names were not accepted. Patients must know the function of each medicine prescribed before they can understand how to use them.

RESULTS
As expected, the subject group answered more questions correctly than the controls, 65 percent versus 51 percent.
The surprise finding was that in each practice the subjects asked better questions or had a more focused visit.

SUBJECTS said they appreciated the opportunity to learn while waiting to be seen and they took the booklet home for further study. They commented positively on the booklet during the visit, for example:

  • Booklet has excellent information that even my five year old son can understand.
  • Facts about types of medicines are very concise and informative.

HEALTH PROFESSIONALS commented on communication with the subjects during the visit, for example:

  • The patient was asking all the right questions.
  • The patient was more confident and more comfortable asking and answering questions during his session.

CONCLUSION AND COMMENT
Patients can learn while waiting to be seen. Professionals who gave reading assignments in the waiting room were able to build on that foundation during a visit. This led to a more efficient and effective visit and an increase in patient satisfaction.

Use of the One Minute Asthma booklet pays for itself when it saves a doctor one minute or respiratory therapist three. Many practices and programs use inadequate materials which waste the time of both the staff and parents.

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