Lay people are often called upon to provide patient education and self-management instruction. The purpose of a study by Partridge and coworkers was to determine whether lay people deliver asthma self-management education as effectively as primary care-based practice nurses. Five hundred and sixty-seven asthma patients on regular maintenance therapy were recruited from 39 general practices in West London and North West England. Fifteen lay educators were recruited and trained to deliver self-management education. An initial consultation of up to 45 minutes was offered either by a lay educator or a practice-based primary care nurse, followed by a second shorter face-to-face consultation and a telephone follow-up for one year. The main outcome measures were unscheduled need for health care, while secondary outcome measures were patient satisfaction and need for courses of oral steroids. The patients were randomized to care by a nurse (N=287) or a lay educator (N=280) and 146 and 171, respectively, attended the first face-to-face educational session. During the first two consultations management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), the authors collected one-year data on use of unscheduled health care. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse-led group required unscheduled care, compared with 65/213 (30.5%) in the lay-led group. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets over the course of one year. Patient satisfaction following the initial face-to-face consultation was similar in both groups.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that it is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses. This sounds like a cost-efficient method to provide self-management training. However, no long-term data were gathered in the study. Unless either the nurse-led or lay person-led groups showed long-term maintenance of change, who is to say that either approach is more effective than having patients watch videos in an outpatient clinic’s waiting room? This is why long-term data for two or more years is so important in assessing self-management in asthma and other chronic disorders.

MR Partridge et al. Can lay people deliver asthma self management education as effectively as primary care-based practice nurses? Thorax, February 2008.