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T L Creer

Publications and source records attributed to T L Creer.

At least 19 recordsLinked to original sources
PubMed1995

A self-management program for adult asthma. Part II: Cost-benefit analysis.

BACKGROUND: We performed a cost-benefit analysis of a previously described self-management program for adult asthma. METHODS: Direct and indirect cost data from 47 subjects who participated in the self-management program were analyzed. In particular, costs incurred by the subjects 1 year before participation were compared with costs incurred 1 year after participation. RESULTS: The cost-benefit analysis indicated that the program was beneficial, reducing the cost of asthma to each patient by $475.29. The benefit came primarily from reductions in hospital admissions (reduced from $18,488 to $1538) and income lost as a result of asthma (reduced from $11,593 to $4589). The asthma self-management program cost $208.33 per patient. Comparison of the program cost with the program benefit produced a 1:2.28 cost-benefit ratio, demonstrating that the program more than paid for itself. CONCLUSION: A self-management program for adult asthma effectively reduced the cost associated with asthma. The findings are especially salient because the subjects' asthma was generally under good medical control when they participated in the program. The savings were therefore not the result of improved medical treatment; medical treatment was a controlled parameter, not a variable, in the self-management study. The self-management program for adult asthma was cost-beneficial.

Adult↗
PubMed1995

A self-management program for adult asthma. Part I: Development and evaluation.

BACKGROUND: We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues. METHODS: Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained. RESULTS: Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills. CONCLUSIONS: The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training.

Adult↗
PubMed1995

Health-related quality-of-life assessment in medical care.

The concept of assessing health-related quality of life has a brief and vibrant history. In this monograph, theoretical issues related to the term and the reasons assessment of quality of life is important are discussed. There is a great deal of ambiguity surrounding definitions of the concept. This equivocation is caused in part by the fact that thinking on both the concept of health-related quality-of-life assessment and the way in which it should be measured are still evolving. Methodologic concerns regarding the assessment of health-related quality of life are discussed, including ways in which the validity and reliability of measurement approaches are established. These characteristics are important because they are necessary to ensure that accurate information is obtained with whatever instrument or procedure is used. Many significant issues relate to the use of quality-of-life assessment, and these are delineated. Consideration and resolution of these issues are prerequisites to the introduction of a given assessment instrument or procedure into a study. A large section of this article is devoted to a review of selected measures of health-related quality of life. Three types of measures are discussed. The first type is referred to as general. These measures are designed to be used across different diseases, different treatments or interventions, and different groups of patients. The reliability and validity of general instruments or procedures, plus their history of empirical use, make them invaluable methods of measurement. The second type of measures is referred to as disease specific. These measures are designed to assess specific diagnostic or patient populations with the goal of detecting responsiveness or clinically significant changes. The ability to assess such changes in a particular patient population has led to major growth in the development and introduction of these instruments in the past few years. The final type of measure consists of batteries of separate instruments that are scored independently. The advantage of using this approach is that the battery can be put together to assess whatever aspects of health-related quality of life need to be measured. Examples of quality-of-life assessment in medical research include a discussion of how various procedures are used to measure the construct with asthma, chronic respiratory disorders, and human immunodeficiency virus (HIV) disease. All three types of assessment--general, disease specific, and batteries of measures--have been used in this respect. Newer methods of assessment, particularly disease-specific instruments and procedures, are also described.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Improving recognition of respiratory sensations in healthy adults.

In two discrimination training studies, we noted improvements in the ability of healthy individuals to discriminate between respiratory sensations. We trained individuals to discriminate between respiratory sensations elicited during inspiration in Experiment 1 and during expiration in Experiment 2. We elicited respiratory sensations by having participants breathe through circuits that differed in their resistance to air flow. Training, in both experiments, was conducted within the context of a task in which individuals judged which member of a series of respiratory circuit pairs was easier to breathe through. To improve the accuracy of judgments, we gave participants feedback of their performance, and we faded air flow resistance. The latter procedure consisted of presenting circuit pairs in order of increasing similarity. Individuals who received performance feedback with fading of air flow resistance demonstrated reliable improvements in discrimination from pre- to posttraining in both experiments, but controls, who received either performance feedback or practice in discrimination did not. These findings may contribute to improving awareness of respiratory sensations in asthma patients, and thereby bolster efforts to manage asthma.

Adolescent↗
PubMed1993

The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire.

The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ) is a paper-and-pencil instrument that was developed to allow physicians, behavioral scientists, and other health care personnel to assess asthma patients' knowledge regarding asthma, their attitudes about their asthma (including their willingness to cooperate with the physician in managing asthma), and their self-efficacy regarding their perceived ability to control the disorder. The KASE-AQ assesses changes in these patient variables following a particular intervention. The KASE-AQ proved to be reliable and internally consistent, and a factor analysis revealed presence of three subscales in the questionnaire (knowledge, attitude, and self-efficacy about asthma). Following asthma education and self-management training, experimental group subjects showed significant improvements in knowledge, attitude, and self-efficacy. Waiting-list control subjects showed similar improvements following training. Both groups' scores at 3-month follow-up remained significantly higher than their baseline scores on all 3 variables.

Adult↗
PubMed1993

A life activities questionnaire for childhood asthma.

The paper describes the development and testing of a paper-and-pencil instrument, the Life Activities Questionnaire for Childhood Asthma, that can be applied to assess activity restriction in children with asthma. It describes how items for the instrument were selected to ensure the validity of the developed instrument. The method by which the reliability of the questionnaire was established is also discussed. The result is a valid and reliable instrument that should have wide applicability in measuring activity restriction because of childhood asthma. The developed instrument has potential use in clinical settings, research, and policy making.

Activities of Daily Living↗
PubMed1992

A life activities questionnaire for adult asthma.

The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.

Activities of Daily Living↗
PubMed1992

Behavioral consequences of illness: childhood asthma as a model.

Several areas of research on childhood asthma are discussed within a transactional model of asthma. The model emphasizes the multidirectional influences that affect the severity of asthma and associated behavioral disability. The initial focus is on how the clinical presentation and morbidity of asthma are affected both by somatic predisposition and by interactions with multiple internal and external elements. Specific elements include emotional factors, neuroimmunology, temperament, and medication side effects. Second, the impact of asthma on the child, his or her family, and segments of the community are described, as are consequences of the disorder on quality of life. Third, there is a synopsis of preventative interventions for reducing the medical and behavioral impact of childhood asthma. The motif is that the interaction of medical and behavioral procedures can improve the management of asthma while consequences of the disorder are mollified. Finally, as examples of a transactional model of asthma, self-management programs for teaching children to become partners with their physicians in establishing and maintaining control over the disorder are described. A representative of self-management--the ACT (Asthma Care Training) program--is described, along with the impact such programs have on children, their families, and institutions. The conclusion emphasizes that asthma is a complicated and unpredictable disorder that puzzles physicians, behavioral scientists, and patients. Although new treatments may be over the horizon, controlling childhood asthma and its consequences currently rests on the cooperation and increased interaction of medical and behavioral scientists.

Asthma↗
PubMed1991

Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children.

We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each child's condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the follow-up period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.

Adolescent↗
PubMed1991

The application of behavioral procedures to childhood asthma: current and future perspectives.

The development and application of behavioral procedures to childhood asthma during the past three decades is reviewed, with particular implications for researchers and practitioners. In particular, the article describes two major categories of procedures that comprise the current state of the art of behavioral intervention; prevention and management of attacks and self-management by patients of their asthma. Much of the discussion focuses on self-management skills, particularly the essential ingredients of data collection, information processing and evaluation, steps required to manage attacks and self-reaction to performance. A final section of the paper speculates on the future directions of applying behavioral techniques to childhood asthma. The need to analyze individual attacks suffered by individual patients is emphasized; in addition, the scientific skills required to successfully manage asthma, performed both by medical personnel and patients, are described. It is hoped that the future will see these skills applied in a manner so that each attack is treated as if it were an experiment.

Asthma↗
PubMed1991

The COPD Self-Efficacy Scale.

Many individuals with COPD develop a lack of confidence regarding their ability to avoid breathing difficulty while participating in certain activities, however minimal the physical demands of the activity may be. This lack of confidence may be expressed as low self-efficacy. As a result of low self-efficacy, COPD patients may refrain from many routine activities of daily living. Identifying situations in which individuals with COPD experience low self-efficacy would allow the development of specific treatment interventions designed to increase the patient's self-efficacy in those situations and consequently increase activity. We developed a 34-item COPD Self-Efficacy Scale (CSES) to assess self-efficacy in individuals afflicted with COPD. The CSES has good test-retest reliability (r = .77), excellent internal consistency (Cronbach's alpha = .95), and a five-factor structure (negative affect, intense emotional arousal, physical exertion, weather/environmental, and behavioral risk factors.

Activities of Daily Living↗
PubMed1991

Predicting asthma in individual patients.

The degree to which asthma attacks were related to seven environmental variables was determined for each of 17 individuals. Using stepwise regression procedures, cladosporium mold, ragweed pollen, and a change in temperature were significant predictors of asthma attacks in 5 of 17 individuals. The information provided by these analyses could prove useful in helping some individuals manage their asthma.

Adult↗
PubMed1991

Prediction of asthma episodes in children using peak expiratory flow rates, medication compliance, and exercise data.

Asthmatic patients demonstrate considerable variation in the extent to which their subjective evaluations and objective measures of airways obstruction correspond. The detection and prediction of asthma episodes have been improved through the use of objective pulmonary measures, such as peak expiratory flow rate (PEFR). Furthermore, information regarding adherence to medication regimens and specific asthma triggers (ie, exercise) may also improve the predictability of asthma in children. The utility of using PEFR values, medication compliance information, and exercise data for the prediction of asthma episodes in individual children was investigated in the present study. Individual logistic regression equations were calculated for ten asthmatic children. In predicting asthma episodes, PEFR was present in the model for nine out of ten subjects; exercise was included for two out of five subjects providing such data; whether an attack had occurred in the preceding 12-hour period was predictive for one out of ten participants; and whether an attack had been experienced in the previous 24 hours was present for four out of ten subjects. Hosmer-Lemeshow values indicated that the models fit the data well for nine subjects (alpha greater than .05). The mean model prediction rate (80.85%) was higher than the mean base rate (75.72%). The relative risk ratio values ranged from 0 to 5.72, with a mean of 3.50. These results suggest that the prediction of episodes may be enhanced by using PEFR, exercise, and time of day.

Adolescent↗
PubMed1990

Environmental control of asthma self-management.

We describe a model of asthma self-management based on environmental control of behavior. The model emphasizes aspects of the environment that either prompt or strengthen asthma self-management behavior. In prompting behavior, environmental events function as behavioral cues; in strengthening behavior, they represent reinforcers. We describe concepts related to cueing and reinforcement, and how these operations might be incorporated in individualized self-management programs. Finally, we discuss evidence supporting asthma self-management programs based on environmental control behavior.

Asthma↗