Bonnie Sibbald

Controlled evaluation of the effects of patient education on asthma morbidity in general practice

Two different patient education programmes for asthma in general practice were evaluated in a controlled trial. Knowledge, self management, and morbidity due to asthma were assessed in 339 patients by means of a questionnaire. One group then received a maximum education programme, a second group received a limited education programme, and a third acted as a control group. 274 patients were reassessed after one 1 year. In both the intervention groups, understanding of asthma was greater after the trial. Only in the maximum intervention group was a significant improvement in knowledge of asthma shown. Neither group showed any change in self-management ability or asthma morbidity that differed significantly from changes in the control group. These simple informational education programmes were ineffective when applied to a general practice population. Further studies of factors affecting attitudes, beliefs, and actions are needed to improve the advice and support given to asthma patients.

Measuring Patient Satisfaction With Life in a Long-Stay Psychiatric Hospital:

A survey of patient satisfaction with physical and social conditions was carried out in the long-stay wards of a large inner city psychiatric hospital in London, Britain. Patient satisfaction was assessed by means of an administered questionnaire which was developed specifically for this purpose. Factor analysis identified eight com ponents of patient satisfaction. Of 143 eligible patients, 104 (73%) successfully completed the interview. Responses showed that patients were generally satisfied with life in the hospital, although levels of satisfaction varied significantly among wards. The factors causing greatest dissatisfaction related to failure to be treated as individuals and to feelings of isolation and apathy. Our findings showed that patients can express views about their conditions which should be useful in planning improvements in care. The questionnaire proved a simple and effective method of measuring satisfaction and may be useful to others concerned with improving the quality of the environment of patients.

Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC) is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM). It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK). We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions.MethodWe collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures.ResultsThere was evidence that rates of missing data were high on PACIC (9.6% - 15.9%), and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94), responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale) than ceiling effects (generally <5%). PACIC demonstrated preliminary evidence of validity in terms of measures of long-term condition care. Confirmatory factor analysis suggested that the five factor PACIC structure proposed by the scale developers did not fit the data: reporting separate factor scores may not always be appropriate.ConclusionThe importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

Birth month variation in atopic and non‐atopic rhinitis

The association of birth month with the development of atopic and non‐atopic rhinitis was investigated in 327 adults in south‐west London. Birth month was a significant risk factor for both atopic and non‐atopic rhinitis in subjects whose age at onset was under 20 yr. but not in those who were older at onset. The odds of being born in May June were 1·68(95%CI: 1·03–2·76) for atopic rhinitic subjects and 1·90 (95% CI: 1·11–3·25) for non‐atopic rhinitic subjects. The birth month effect was not related to the criteria used to determine subjects “atopic status or to subjects” clinical characteristics, apart from their age at onset. The findings suggest that atopic and non‐atopic rhinitis have a common aetiology which does not depend on infant sensitization to seasonal allergens.

Extrinsic and intrinsic asthma: influence of classification on family history of asthma and allergic disease

The distributions of asthma, hay fever and eczema were examined in the first degree relatives of 516 asthmatics grouped according to atopic status, history of hay fever/eczema and history of asthma provoked by pollens, dust or animals. The prevalences of both asthma and eczema in relatives were strongly correlated with the presence of hay fever/eczema in probands and to a lesser extent with their atopic status. The prevalence of hay fever in relatives was strongly correlated with both the presence of hay fever/eczema and the degree of atopy in probands. In contrast, allergic provocation of asthma in probands did not influence the prevalences of asthma, hay fever or eczema.

An open cross‐over trial comparing two doses of astemizole and beclomethasone dipropionate in the treatment of perennial rhinitis

An open cross‐over trial comparing astemizole with intra‐nasal aqueous beclomethasone dipropionate was carried out in forty‐five perennial rhinitis patients attending a S.W. London general practice. Each drug was given for 12 weeks, separated by 4–8 weeks without medication. The principal outcome measure was a 7‐day symptom diary completed by patients during weeks 4, 8 and 12. Patients were skin tested to seven common inhalant allergens. Half the patients beginning either regime failed to respond adequately within 2 weeks. Doubling the dose in these patients achieved satisfactory symptom control in an additional 67% on beclomethasone dipropionate and 45% on astemizole. Symptom diary scores showed beclomethasone dipropionate to be significantly more effective than astemizole in the treatment of skin test negative patients; but the two drugs were of equal benefit in the treatment of skin test positive patients. Sneezing and rhinorrhoea were the same on both drugs, but nasal blockage tended to be less severe on beclomethasone dipropionate. There was no significant difference between drugs in the frequency or duration of side effects. Beclomethasone dipropionate and astemizole are equally effective in the symptomatic treatment of atopic perennial rhinitis, but beclomethasone dipropionate may offer superior symptom relief in non‐atopic perennial rhinitis.

Genetics of asthma and atopy: an overview

Asthma is a multifactorial condition whose expression depends on both genetic and environmental controls. The genetic controls are not fully understood, but are thought to include the inheritance of a general susceptibility to allergic disease together with a specific liability to asthma. Atopy, the capacity to produce high serum levels of IgE, plays an important part in determining susceptibility to allergic disease. Family and twin studies show that atopy is under strong genetic control, although its mode of inheritance is unclear [1]. In nuclear families, high serum IgE appears to be inherited as an autosomal recessive trait with an additional polygenic component. In contrast pedigree studies show evidence of genetic heterogeneity, there being a major gene effect demonstrable in some families, but not in others. The disagreements can be attributed partly to the differences between investigators in their choice of analytic model, and partly to the difficulty of controlling for environmental factors which affect serum levels of IgE.