Studies such as this emphasize the need for validated outcome measures to evaluate the effects of educational interventions for physicians and other health care professionals.

The basis for early recognition of allergic disease and development of a plan for therapeutic management depends on the appropriate education of the physician. The majority of health care of the allergic patient will be delivered by primary care providers who are also pediatricians, internists, or family practitioners. For more serious cases, a subspecialist in allergy-immunology (for allergy and asthma), or pulmonology (for asthma) may be required. Thus, allergic diseases should be emphasized at several levels of medical education. The mechanisms of allergic diseases should be taught during the basic science years of medical school, and the diagnosis and therapy of allergic diseases should be emphasized during the clinical years. Postgraduate training in family practice, pediatrics, and internal medicine should include the diagnosis and management of allergic disease, because of the high incidence and prevalence of these medical problems. Finally, fellowships in allergy and immunology provide the basis for subspecialty practice and of future faculty.

CONCLUSIONS AND RECOMMENDATIONS

A plethora of education and self-management programs exists for asthma and allergy. These programs are readily available to anyone through federal agencies such as NHLBI, or private groups such as the Asthma and Allergy Foundation of America, the American Lung Association, and pharmaceutical companies. Despite methodological weaknesses in the initial application of some of these programs, many have produced a number of positive results.

In the future, there should be closer linkage between the acquisition of knowledge about asthma self-management and the subsequent performance of these skills. This goal can be achieved by combining available educational components with additional elements as required to tailor specific programs to individual patients, who have varying degrees of severity of disease and are sensitized to different allergens. The result of such an approach should be not only more germane educational materials for patients but a reduction in the amount of information they need to learn and remember. Because memory repeatedly has been shown to be a significant factor in decisionmaking, particularly with an intermittent condition such as asthma, emphasizing basic self-management skills leads to better asthma management decisions. Better decisionmaking, in turn, enhances the performance of self-management skills (Creer, 1990).

There are few scientifically tested educational tools and materials designed to teach physicians and other health care providers about allergic



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