Bakgrund: Patienter med typ 2 diabetes har ett uttalat behov av stöd och kunskap för att utföra egenvårdsåtgärder, integrera sjukdomen i det dagliga livet för att hålla en bra blodsockernivå och därmed undvika sena komplikationer. Syfte: Syftet med studien var att beskriva de erfarenheter som personer med typ 2 diabetes erhållit genom att deltaga i en personcentrerad stödgrupp. Metod: Studien genomfördes med en empirisk kvalitativ design med induktiv ansats. Elva personer som hade deltagit i stödgrupp för personer med typ 2 diabetes deltog i semistrukturerade intervjuer. Konventionell kvalitativ innehållsanalys ansats användes vid analysen. Resultat: Deltagandet i en personcentrerad stödgrupp för personer med typ 2 diabetes innebar att de fick träffa andra personer med samma sjukdom men med skilda livssituationer och erfarenheter, vilket utgjorde en grund för diskussioner och reflektioner där de fick ny kunskap och förståelse. Stödgruppens utformning och process med förutbestämda teman, närvaron av professionella diabetessjuksköterskor och det öppna samtalsklimatet där deltagarna fick delge sina åsikter ansågs mycket givande. Konklusion: Genom medverkan i stödgrupper erhöll deltagarna nya insikter och perspektiv på den egna livssituationen. De fick också insikt i att dagliga livet kräver olika lösningar för olika personer. / Background: Patients with type 2 diabetes have an expressed need of support and knowledge to perform self-care interventions, to integrate the illness in daily life as well as to avoid complications. Aim: The aim of this study was to identify and describe the experiences of participating in a support group in patients with type 2 diabetes. Method: The study was performed with an empirical qualitative design with an inductive approach. Eleven participants who had attended the support group for patients with type 2 diabetes participated in semi-structured interviews. Conventional qualitative content analysis was used in the analysis. Results: Participation in a person-centered support group for patients with type 2 diabetes meant that they met others with the same disease but with different life situations and experiences, which provided a basis for discussions and reflections where they received new knowledge and understanding. The design and process of the support group with preselected themes, the presence of professional diabetes nurses and an open debate atmosphere where participants could share their opinions were considered rewarding. Conclusion: Participants in the support groups were given new insights and perspectives on their own life situation, and also a realization that the problems of everyday life demand are individual and requires various solutions.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2010. / Patients’ knowledge about the effectiveness of interventions is now recognized as an important facilitator of the implementation of evidence in practice. Evidence-based, patient education programs aim to impart knowledge about the efficacy and effectiveness about interventions to individuals. However, there is currently a lack of structured evidence-based educational programs to educate patients about the evidence-base for interventions prescribed by the health professionals in the field of orthopaedics. OBJECTIVE: The main objective of this study was to develop and validate an Arabic version of an evidence-based educational program for patients who are scheduled to undergo ACL reconstruction surgery in UAE, based on available evidence collated through a systematic review process. METHODS: A systematic review was conducted to generate clinical recommendations which were used to develop the evidence-based educational program. The evidence-based information was derived from secondary research to determine which rehabilitation strategies were most effective in improving outcome measurements following ACL reconstruction surgery. A pre-final draft of the evidence-based educational program was prepared and forward and back translated from English into the Arabic language. Feedback groups of ACL patients and physiotherapists were used to determine the content and face validity of the program. The final draft was validated in a group of 40 ACL patients waiting to undergo ACL reconstruction surgery at Zayed Military hospital and Abu Dhabi Knee and Sports Medicine Centre in the UAE, using checklists. RESULTS: A total of 40 patients undergoing ACL reconstruction surgery consented to participate in this study. All the subjects were male. The age range was between 18 to 38 years old with mean age of 28.5 years (SD 5.75). Most of the patients (65%) underwent ACL reconstruction surgery to the right knee. Of the total sample (n=40), the majority of the subjects who participated in this study (90 %), had ACL surgery for the first time. Most of the responses to the evidence-based educational program checklist were positive. iv CONCLUSION: It can be recommended that the newly-developed evidence-based educational program is a valid tool which can be given to ACL patients prior to ACL reconstruction to prepare them for the rehabilitation postoperatively. By informing patients of their condition, the expected outcomes of their condition and the effect of doing exercises to improve their condition, the patients will be more encouraged to partake in rehabilitation, as they know it is for their own good. This will ultimately improve overall patient care and improve management of ACL patients.

Bakgrund:Att vara ung och få en kronisk sjukdom innebär för de flesta en omvälvande förändring i livet som kan påverka hela familjen. Diabetes typ 1 kräver mycket av en ung person och dennes familj, t.ex. att följa ett regelbundet schema för insulinintag, blodsockermätning, att hålla en särskild diet och föra regelbunden dagbok över blodsockervärdena, regelbunden fysisk aktivitet och att hantera lågt eller högt blodsocker. Compliance beskriver hur patientent vid en viss sjukdom följer råd och ordinationer. Syfte: Syftet med litteraturstudien var att beskriva faktorer som har betydelse för compliance hos ungdomar med diabetes typ 1. Metod: Studien var baserad på 11 vetenskapliga artiklar med både kvantitativ och kvalitativ ansats. Resultat: Studien betonade vikten av att sjuksköterskan, den diabetesutbildade sjuksköterskan och föräldrarna i hanteringen av diabetesvård riktar adekvat information till ungdomarna. Ungdomar som har en kronisk sjukdom uppnådde god compliance när de hade energi, viljestyrka, kände motivation samt tog eget ansvar för sin behandling. Störst påverkan på compliance hos dessa ungdomar är när familj och vänner kan medverka, därefter kommer sjukvårdens roll och på tredje plats kommer egenvården. Slutsats: Sjukdomen skapar påfrestningar på familjen och det är viktigt med stöd till den unge från familj- anhöriga och vänner, sjuksköterskan och läkaren. Ungdomar med diabetes typ 1 måste i sitt dagliga liv se till att hålla en jämn och stabil blodsockernivå för att uppnå ett gott behandlingsresultat. Motion förbättrar känsligheten för insulin, ökar förbränningen av glukos, minskar hjärt- och kärlsjukdomar och förebygger fetma / Background: To be young and have a chronic disease involving the most revolutionary change in life that can affect the whole family. Type 1 diabetes requires a lot from adolescents and their families, such as to follow a regular schedule for insulin intake, blood glucose monitors, to keep a special diet and keep a regular diary of blood glucose control, regular physical activity and to deal with high or low blood sugar. Compliance describes how patients with specific disease follow advice and prescriptions. Aim: The aim of this literature study was to describe the factors that are important for compliance in adolescents with type 1 diabetes. Method: The study was based on 11 scientific articles in both quantitative and qualitative approach. Results: The study emphasized the importance of the nurse, the diabetic trained nurse, and that parents should in the management of diabetes care provide adequate information to adolescents. Adolescents who have a chronic disease achieved good compliance when they had the energy, willpower, motivation and felt responsibility. The factor that has the greatest impact on compliance in adolescents with type 1 diabetes is when family and friends can participate, then the medical establishments and in the third place comes self-care. Conclusion: The disease creates pressures on family and it’s important for the adolescence to have support from families, relatives and friends, nurses and doctors. Adolescents with type1 diabetes must in their daily lives try to keep a steady and stable blood sugar level in order to achieve good treatment outcomes. Exercises improve insulin sensitivity, increase the burning of glucose, reduce cardiovascular disease and prevent obesity.

Patientenzufriedenheit spielt eine zunehmend wichtige Rolle im Qualitätsmanagement im Gesundheitswesen. Die ärztliche Empathie gilt dabei als ein wesentliches Element, um eine hohe Patientenzufriedenheit zu generieren. Vor dem Hintergrund abnehmender ärztlicher Empathie während der Aus- und Weiterbildung wird in der vorliegenden Arbeit untersucht, inwieweit Assistenzärzte im Vergleich zu Fachärzten die Patientenzufriedenheit in einer anästhesiologischen Prämedikationsambulanz beeinflussen. In einem prospektiv-beobachtendem Studiendesign wurden die Zufriedenheit der Patienten, deren demografische und medizinische Daten, deren vorhandene Vorinformationen sowie organisatorische und logistische Faktoren mithilfe eines selbst erstellten ZUF-8 adaptierten Fragebogens erhoben und anhand des Ausbildungsstandes des prämedizierenden Arztes der Assistenz- oder Facharztgruppe zugeteilt. Dabei zeigten sich Gesamtzufriedenheitswerte auf durchgehend hohem bis sehr hohem Niveau. Feine Unterschiede zugunsten der Assistenzärzte wurden in den Items Gesprächsqualität, Allgemeinzufriedenheit und Freundlichkeit gefunden. Im Bereich der organisatorischen und logistischen Faktoren ergaben sich u.a. länger empfundene Wartezeiten bei den Assistenzärzten. Abschließend macht diese Arbeit deutlich, dass Assistenzärzte im Vergleich zu Fachärzten trotz abnehmender ärztlicher Empathie eine gleichweg hohe Patientenzufriedenheit generieren können. Eine Verbesserung der organisatorischen Abläufe könnte eine weitere Optimierung der Patientenzufriedenheit versprechen.

Bakgrund: Sjuksköterskans arbete med patienter diagnostiserade med diabetes mellitus typ-2 (DM2) följer riktlinjer och lagar. Centrala delar i omvårdnaden är personcentrerad vård, delaktighet, patientutbildning och egenvård. Tidigare forskning påvisar att det finns brister i utbildningen av patienter med diagnosen och att en stor del sjuksköterskorna inte har tillräcklig pedagogisk utbildning. Syfte: Syftet med studien är att belysa hur sjuksköterskor i primärvården arbetar i första fasen av arbetet med patienter nydiagnostiserade med DM2. Metod: Kvalitativ studie baserad på semi-strukturerade intervjuer med en induktiv ansats och innehållsanalys som analysmetod. Resultat: De centrala fynden i studien är att de intervjuade sjuksköterskorna i arbetet med vården av patienter med DM2 strävar efter att ge så god vård de har möjlighet till genom patientutbildning, delaktighet och egenvård. Det gör de genom att vara lyhörda och arbeta på ett personcentrerat sätt. Slutsats: Sjuksköterskorna i studien strävar alla efter att arbeta personcentrerat där lyhördhet, delaktighet och egenvård är i fokus. I stort är de nöjda med hur arbetet fungerar, men skulle vilja ha mer tid och resurser. / Background: Nurses working with patients diagnosed with diabetes mellitus type-2 (DM2) follow guidelines and laws. Key components of the care is person-centered care, participation, patient education and self-care. Previous research show that there are shortcomings in the education of patients diagnosed with DM2 and that a large number of nurses do not have adequate pedagogical training. Objective: The aim of this study is to highlight how nurses in primary care work in the first phase with patients newly diagnosed with DM2. Method: Qualitative study based on semi-structured interviews with an inductive approach and content analysis as a method for analysis. Results: The main findings of the study are that the interviewed nurses in their work with patients with DM2 strive to provide the best care possible through patient education, participation and self-care. They do this by being responsive and working in a person-centered way. Conclusion: The nurses in the study all strive to work person-centered where attentiveness, participation and self-care is in focus. Overall they are satisfied with their work, but would like to have more time and resources.

L'Approche Centrée Patient (ACP) permet sur le plan conceptuel la réalisation d'une démarche éducative vis-à-vis du patient diabétique de type 2. Mais la question de son fonctionnement se pose en pratique clinique de médecine générale. Dans le cadre d'une étude exploratoire qualitative phénoménologique, une Démarche Educative DEADIEM a été testée auprès de 10 patients diabétiques de type 2 inclus par 5 médecins généralistes pour en comprendre son fonctionnement. Cette démarche comprenait l'exploration de la perspective du patient, ce qui est VRAI (Vécu, Représentation, Attentes, Important) pour lui, une démarche explicative, des conseils hygiéno-diététiques adaptés et un objectif de compréhension commune avec le médecin avec évaluation à 3 mois de ses résultats. En confrontant les données du discours avec les modèles transthéorique et transactionnel par procédure de triangulation théorique, cette démarche a corroboré une dynamique d'adaptation « coping », des processus expérientiels et comportementaux favorisant ou pas des changements. Les médecins traitants ont été sollicités pour parler de leur perception de la relation. L'étude a illustré l'interaction symbolique qui existe entre des représentations « personnages » que chacun se fait de l'autre et qui peuvent bloquer ou faciliter la relation et la compréhension commune. Les médecins traitants ont pu exprimer de manière réaliste leurs limites et les difficultés de la relation transférentielle. A l'issu de cette étude, l'ACP, enrichi par d'autres modèles, est apparue comme un processus thérapeutique systémique qui peut être accessible à tout médecin généraliste, enseignable et faire l'objet de travaux de recherche complémentaires / The Patient Centered Approach (PCA) allows, on the conceptual level, to undertake an educative counseling program for type 2 diabetic patients. The question of its efficiency remains unclear in everyday general practice. In the setting of an exploratory phenomenological qualitative research DEADIEM, an experiential educative counseling based on a patient centered care model, was tested on a population of ten type 2 diabetic patients selected by five general practitioners to understand its functioning. This study investigated the patient’s perspective, their real experience, beliefs, expectations, references. An explanatory procedure and adapted hygieno-dietetic counseling was proposed together with an objective of common ground between patient and practitioner. The results were evaluated after three months. By triangulating data extracted from the patient’s transcript with other transtheoretical model and transactional models, the study revealed coping dynamic, experiential and behavioral processes which favoured or not changes. General practitioners were asked to express their perception of the physician patient relationship. The study illustrated the symbolic interaction existing between the “personal fronts” representations that anyone has about others that may block or facilitate relation and common understanding. GPs have been able to express in a realistic way their limits and the difficulties of transferential relationship. At the end of the study, PCA, enriched by other models appeared as a systemic therapeutic process that can be of ready access to any GP, can be taught and must be the subject of further research

The purpose of the study was to evaluate the health education for clients diagnosed with diabetes mellitus by nurses working in the diabetes clinic of the specific hospital. The quantitative descriptive cross sectional design used two questionnaires to collect data from all 20 nurses working in the diabetes clinic and from a convenient sample of 132 clients diagnosed with diabetes mellitus, making use of the health services at the diabetes clinic of the hospital. Data was analysed by a computer program, statistical package for social science (SPSS). Measures were taken to ensure acceptable ethical practice, validity and reliability of the study. Findings revealed the absence of official documents to guide the health education and other factors, such as not knowing the learning needs of the clients, not utilising teaching methods optimally. Recommendations address the development of standard procedures, lesson plans, recording of health education sessions and education skills development for the nurses. / Health Studies / M. A. (Nursing Science)

À partir d’une approche psychosociale de la situation thérapeutique, cette thèse interroge les processus et les enjeux psychosociaux associés au développement des compétences psychosociales dans le contexte de l’éducation thérapeutique du patient diabétique de type 1. Suite aux limites identifiées par une revue systématique de la littérature (N = 60 articles), nous avons réalisé une recherche qualitative auprès d’adolescents diabétiques (N = 28) dans le but de mieux comprendre leurs besoins en termes de compétences psychosociales. Ce travail nous a ensuite amenés à dégager trois perspectives de recherche que nous avons exploités à partir de différentes stratégies méthodologiques : une étude expérimentale (N = 102) et une étude transversale (N = 261) auprès d’adultes diabétiques ; une étude prospective visant à suivre l’évolution du profil sociocognitif d’adolescents diabétiques (N = 24) ; et une étude qualitative à partir dix focus groups composés d’adolescents diabétiques (N = 26), de leurs parents (N = 9) et de professionnels de santé (N = 11). L’articulation de ces études montre que les compétences psychosociales sont régulées par des processus psychosociaux qui sont en jeu dans le contexte dynamique de la relation thérapeutique. Ces compétences s’inscrivent dans un système d’actions et d’interprétations socialement façonné par des enjeux thérapeutiques et relationnels ainsi que par une symbolique sociale. Leur développement semble déterminé par le statut social et l’identité des acteurs, les motivations et les attentes propres à chacun, ainsi que par la représentation de l’autre mobilisée pour construire le climat de la relation thérapeutique. / Based on a psychosocial approach to the therapeutic situation, this thesis examines the psychosocial processes and issues involved in the development of psychosocial skills in the context of the therapeutic education of type 1 diabetic patients. Following the limitations identified by our systematic review (N = 60 articles), we conducted a qualitative research with diabetic adolescents (N = 28) in order to better understand their needs in terms of psychosocial skills. This work led us to identify three research perspectives that we carried out using different methodological strategies: an experimental study (N = 102) and a transversal study (N = 261) with diabetic adults; a prospective study to following the evolution of the sociocognitive profile of adolescents with diabetes (N = 24); and a qualitative study using ten focus groups of adolescents with diabetes (N = 26), parents (N = 9) and health professionals (N = 11). The articulation of these studies shows that psychosocial skills are regulated by psychosocial processes that are at stake in the dynamic context of the therapeutic relationship. These skills are part of a system of actions and interpretations socially shaped by therapeutic and relational issues as well as by a social symbolism. Their development seems to be determined by the social status and identity of the actors, their motivations and expectations, and by the representation of others mobilized to build the climate of the therapeutic relationship.

A hipertensão arterial é uma doença crônica, caracterizada pelo aumento constante da pressão sangüínea acima da normalidade (140 mmHg para a sistólica e 90 mmHg para a diastólica). Tem alta prevalência, em geral assintomática e é determinada por diversos fatores como raça, hereditariedade, idade e hábitos de vida relacionados à alimentação e à prática de exercícios físicos. É um dos maiores fatores de risco de morbidade e mortalidade cardiovasculares no mundo todo, causando além dos sérios problemas relativos à saúde, alto custo social. A falta de adesão às recomendações que são dadas aos pacientes é uma das causas do insucesso no tratamento dos indivíduos hipertensos, tornando-se um problema de saúde pública, encontrado em países do mundo todo. Por ser a hipertensão arterial uma doença assintomática é mais difícil motivar seu tratamento. Para isso, é fundamental a prática de uma sistemática contínua de orientação ao paciente pela equipe de saúde. O presente trabalho teve como objetivo estudar a repercussão de um programa educacional para melhorar a adesão do paciente ao tratamento. Foi aplicado pelo farmacêutico e comparado a um grupo controle, em pacientes atendidos pelo ambulatório de hipertensão do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo, através de palestras e orientação individualizada. Os resultados foram avaliados por meio de questionário, dosagens de sódio e potássio urinário, controle de pressão arterial, peso corpóreo, medidas de circunferência de cintura e quadris e de exames bioquímicos laboratoriais, entre outras variáveis. Verificou-se que os pacientes do grupo experimental apresentaram maior redução da pressão arterial sistólica e diastólica, do nível sé rico de triacil-gliceróis e da relação entre cintura/quadril, além de apresentarem aumento da excreção urinária de potássio em volume de 24 horas e da porcentagem de acertos em questionários referentes a aspectos gerais sobre hipertensão arterial, em relação aos pacientes do grupo controle. Tais resultados indicam aumento de adesão ao tratamento, mediante o processo educativo oferecido ao grupo experimental. / Hypertension is a chronic disease featured by a continuous rise in blood pressure above normal levels (140mmHg for systolic pressure and 90mmHg for diastolic pressure). A highly prevalent disease, it is not usually accompanied by symptoms and is determined by a number of factors, such as race, heredity, age, and living habits related to food intake and physical exercises. It is one of the highest risk factors for cardiovascular morbidity and mortality, thus leading not only to serious health disorders, but also to high social expenditure. Unsuccessful treatment of individuals who suffer from hypertension is in part a consequence of the fact that patients do not follow recommendations, which ultimately causes hypertension to be a public health issue throughout the world. As patients do not display any symptoms, they turn out to be less easily motivated to undergo treatment. It is therefore utterly important that health professionals provide patients with continuous, systematic guidance. This project analyzes the effects of an educational program aimed at fostering patients adhesion to medical treatment. It was carried out by a pharmacist and compared to a control group comprised by patients who sought medical assistance at the University Hospital hypertension clinic of the Medical School of the University of São Paulo, by means of lectures and private guidance. Results were assessed by means of a questionnaire, urinary potassium and sodium dosages, arterial pressure control, corporeal weight, waist and hip circumference measures, laboratory biochemical tests, among other variables. Results showed that the educational process addressed to the said experimental group was effective as to lower systolic and diastolic blood pressure, serum triacylgycerol levels and waist-hip ratio. An increase in urinary potassium excretion was also observed within a 24-hour volume, along with a greater number of correct answers to general questions about hypertension among patients in the control group. Such results are an evidence that the number of individuals who adhered to medical treatment increased as a consequence of the educational process provided for the experimental group.

Introdução: A educação em saúde é considerada essencial no controle da asma. A implantação de um programa de educação (PE) com automanejo tem impacto positivo na melhora da qualidade de assistência em asma. Entretanto, os benefícios de um PE ainda são controversos em função das barreiras estruturais. Objetivo: Avaliar o controle clínico de pacientes submetidos a um programa de automanejo associado automonitorização e auto-tratamento comparando-os com dois grupos em atendimento ambulatorial de rotina, com e sem aplicação de um PE. Ainda, mensurar o conhecimento da doença e técnica inalatória, os índices de qualidade de vida, sintomas de ansiedade e depressão e a alfabetização funcional em saúde. Métodos: Trata-se de um estudo aleatorizado, controlado, de grupos paralelos, alocados em três grupos: grupo controle (GC), educação (GE) e automanejo (GA) durante um período de doze meses. Foram incluídos 110 pacientes com asma persistente moderada e grave. O PE foi oferecido para pequenos grupos nos dias de consulta, e consistiu de aulas expositivas divididas em módulos: (1) fisiopatologia e controle ambiental; (2) sinais/sintomas da asma; (3) tratamento e treinamento da técnica inalatória. O GA ainda recebeu um diário de sintomas e um plano de ação individualizado por escrito. Para avaliar o controle da doença foi utilizado a média de pontos do teste de controle da asma (ACT) e o percentual de pacientes com escore 20. Outros questionários incluídos foram: conhecimento sobre a doença (QCA), qualidade de vida relacionada à asma (AQLQ-s), escala hospitalar de ansiedade e depressão (HADS) e o teste de alfabetização funcional (s-TOFHLA). Resultados: Em dois anos, 84 pacientes completaram o estudo. Os grupos eram homogêneos em relação às características basais. A média do ACT aumentou de 14 para 18 pontos, sendo que 48% dos pacientes do GA atingiram o controle da asma. Os GA e GE aumentaram o conhecimento da doença e técnica inalatória para 100%. E os sintomas de ansiedade diminuíram em 14% e 12%, respectivamente. O escore do AQLQ-s foi clinicamente relevante com aumento significativo maior que 0,5 pontos nos dois grupos. O s-TOFLHA foi classificado como alfabetização em saúde adequada com escore médio de 76 pontos. Conclusões: PE associado automanejo durante a rotina de atendimento ambulatorial mostrou impacto relevante sobre a melhora clínica de pacientes portadores de asma moderada e grave. O PE aumentou o conhecimento sobre a doença e tratamento medicamentoso, com melhora da qualidade de vida relacionada à saúde e os sintomas de ansiedade. Nesta população os pacientes apresentaram adequada alfabetização funcional em saúde. / Background: Health education is considered essential in asthma control. The implementation of an education program (EP) with self-management has a positive impact on improving the quality of care in asthma. However, the benefits of an EP are still controversial according of structural barriers. Objective: Evaluate the clinical control of patients submitted a self-management program associated with selfmonitoring and self-treatment comparing with two groups during the routine outpatient visits with and without the EP application. Also, measure the disease knowledge and inhalation technique, the indices of quality of life, symptoms of anxiety and depression and functional health literacy. Methods: This was a randomized study, controlled, divided into three groups: control group (CG), education (EG) and self-management (AG) during twelve months. The study included 110 patients with moderate and severe persistent asthma. The EP was applied to small groups on outpatient visit days, consisted of lectures divided into three parts: (1) pathophysiology and environmental control; (2) asthma symptoms; (3) treatment and training in the inhalation technique. The AG also received a symptoms diary card and written personal asthma action plan. Disease control was measured by the score of asthma control test (ACT) and the percentage of patients with scores 20. Other questionnaires included: disease knowledge (UDQ), asthma quality of life (AQLQ-s), hospital anxiety and depression scale (HADS) and functional literacy health test (s- TOFHLA). Results: In two years, 84 patients completed the study. Groups were similar in baseline characteristics. The mean ACT increased from 14 to 18 points, with 48% of patients in the AG achieved better control of asthma. The AG and EG increased disease knowledge and inhalation technique up to 100%. And the anxiety symptoms decreased 14% and 12%, respectively. The AQLQ-s score was clinically relevant with a significant increase of more than 0.5 points in both groups. The s- TOFLHA was classified as adequate health literacy with a mean score of 76 points. Conclusions: EP associated with self-management during routine outpatient visit showed significant impact on the clinical improvement in patients with moderate to severe asthma. The EP increased knowledge about the disease and drug treatment, with improvement in quality of life and symptoms of anxiety. In this population patients had adequate functional health literacy.