Development and Evaluation of Self-Management Systems for Children with Asthma: Self-MANAGE and Co-MANAGE

摘要

This report describes a four-year collaborative research effort by the American Institutes for Research and the Kaiser-Permanente Medical Groups in Santa Clara and San Jose, California, to (a) identify behaviors actually practiced by children in the effective/ineffective self-management of their asthma, (b) determine whether effective self-management behaviors can be developed in children by a structured educational approach, (c) determine whether this will improve their overall medical status and psychosocial functioning, and (d) package the program for wider dissemination. The study resulted in a typology of self-management behaviors; a group-administered educational program, Self-MANAGE, to increase the self-management capabilities of asthmatic children ages, 9-13; and an individualized program, Co-MANAGE, to identify and remove obstacles to selfmanagement for children with difficult to manage asthma. Self-MANAGE requires four weekly one-hour sessions of a patient educator with groups of children and simultaneous sessions with parents. Co-MANAGE involves variously the physician, patient educator, patient and parents in weekly meetings of from 15 minutes to an hour in length over a 4-6 week period. The report contains results of pilot testing demonstrating significant changes in self-management behavior and, for Co-MANAGE patients, a clinically significant reduction in use of emergency facilities and emergency medications.