Evaluating the outcome of two teaching methods of breath actuated inhaler in an inner city asthma clinic.

OBJECTIVES: Our objective was to compare two different teaching methods used to educate patients in the use of a breath actuated inhaler (BAI) and to assess the impact of its continued use on their metered-dose inhaler (MDI) technique. DESIGN: Prospective, randomized, controlled trial. SETTING: Adult Pulmonary/Asthma clinic of Cook County Hospital, Chicago, IL. PATIENTS: Diagnosed, stable asthmatics. INTERVENTION: The patients were randomized into two groups. The experimental group received verbal instructions and demonstration on breath actuated inhaler technique while the control group received written instructions only on BAI use. The metered dose inhaler technique of both groups of patients was also evaluated. MEASURES: A checklist evaluating the key aspects of proper BAI and MDI inhalation techniques was used to assess the use of both types of inhalers at entry into the study and upon postintervention follow-up at 8 to 20 weeks. RESULTS: At baseline, 97% of patients in the experimental group and 83% of patients in the control group were initially able to demonstrate BAI inhalation technique correctly. Upon follow-up, 82% of the control group and 68% of the experimental group were able to use the BAI correctly, which was a statistically significant deterioration in the experimental group. In both of these groups, there was a statistically significant improvement in MDI technique. CONCLUSIONS: Written instructions alone may be an adequate teaching tool for proper inhalation technique of BAI. Continued BAI use appears not to impact adversely on proper MDI technique.

Outcome of case management and comprehensive support services following policy changes in mental health care delivery.

UNLABELLED: An assessment of policy toward the care of seriously mentally ill (SMI) persons residing in a suburban Chicago community was undertaken. Results indicated the SMI population was classically "underserved." Few alternatives to a state inpatient hospital were being utilized. A policy change in SMI care was instituted by the local community mental health board which included implementation of the Unified Services Program (USP). The features of the USP were: centralized case management and outreach; and an expansion of service philosophy into a comprehensive, multidisciplinary service model of mental health delivery. METHODS: This study examined SMI service utilization, quality of life, and satisfaction with care outcomes following 12 months of USP exposure. Fifty percent of USP caseloads were randomly sampled for study participation. USP study results were compared to a large SMI population with similar exposures in another state. RESULTS: 100% of USP SMI reported to be satisfied or very satisfied with their place of residence compared to the state hospital; and 100% were satisfied or very satisfied with the USP overall. Eighty two to 100% of the study participants rated their status as better than before enrolling in USP. SMI utilized USP services, and service combinations which they find useful (88 to 100%); and felt they could not access their services without USP case managers or outreach. Compared to New York State SMI, study SMI reported similar scores, but superior ratings on "services/facilities." CONCLUSION: The study supports use of the USP for SMI living in the community, and also identified areas for programmatic improvement.