Computerised asthma action plans

To the Editor: The recent study by Wilson,1 and its accompanying editorial by Walters and colleagues,2 highlight a number of issues about written asthma action plans (AAPs).

The utility of AAPs is controversial. However, a number of points are more certain:

• AAPs will achieve nothing unless they are part of a comprehensive program of therapy, patient education and review.

• AAPs must be individualised, and must cover several aspects of self-management, including ongoing maintenance therapy and future acute episode treatment (including the current episode if this has triggered the patient’s attendance).

• AAPs cannot improve patient care if doctors don’t take the time and effort to write them, and if patients don’t have them available at the time of need, particularly during acute episodes.

AAPs are a useful communication tool, and an aid in consistency of care, provided patients and all their doctors have up-to-date copies of the same plan.

To help with the complex and time-consuming task of producing customised AAPs, we developed a computerised AAP generator which runs in a standard web browser. Individualised AAPs are produced with minimal typing and a few mouse clicks in less than 45 seconds. All plans have sections for future acute episodes. Sections for preventer medications and the current episode only appear when selected. All asthma medications currently available in Australia are selectable from drop-down menus, and these lists are updated regularly. There are several prompts to encourage best-practice care.

Enough copies are produced for the family, school, kindergarten, child minder, grandparents, general practitioner, and hospital notes.

The AAP generator was made available on the Royal Children’s Hospital intranet in July 1999. This intranet version logs, in detail, all use of the plan and the recommended therapies, without any patient identification. About 19 500 plans have been generated since.

We have not formally evaluated this system, but we do know, from informal feedback and from our records showing that many of them have used it hundreds of times each, that our staff find it useful.

AAPs are only a part of the “education package” required for patients with asthma. If it is quick and easy to generate good AAPs, it is to be hoped this will encourage doctors to produce them, while also giving them more time to concentrate on the explanation and discussion of care.

The AAP generator is available for free download from our website (www.rch.org.au/clinicalguide/asthmaPlanRequest.php).