Home visits may improve asthma control in adults

the Clinical Advisor take:

For low-income adults with uncontrolled asthma, visits from community health workers (CHWs) improved disease control results of a study published in JAMA Internal Medicine indicate.

To determine if CHW home visits for adults with uncontrolled asthma improved outcomes compared with usual care, James Kreiger, MD, MPH, of the University of Washington in Seattle, Wash., and colleagues conducted a randomized parallel group study with one-year follow-up. The participants were aged 18 to 65 years and had documented uncontrolled asthma.

 Of the 443 eligible patients, 177 patients were assigned to an intervention. The intervention included a mean of 4.9 visits from CHWs throughout a one-year period to assess asthma control, self-management, and home environment. CHWs also provided asthma self-management support to patients enrolled in the intervention group.

Patients in the intervention group had significantly greater increases in mean symptom-free days per two weeks (2.02; P<0.001) and quality of life (0.50 points; P<0.001) relative to the control group after adjustment for age, sex, race/ethnicity, and education level.

Mean urgent health-care use episodes in the past 12 months decreased significantly and similar in both groups, from a mean of 3.46 to 1.99 episodes in the intervention group (mean change, -1.47; P<0.001) and from a mean of 3.30 to 1.96 episodes in the control group (mean change, -1.34; P<0.001).

“The provision of in-home asthma self-management support by CHWs to low-income adults with uncontrolled asthma improves asthma control and quality of life but not unscheduled health-care use,” concluded the investigators.

“Additional studies are needed to confirm these findings and determine the value of wider implementation of this approach.”

Home visits may improve asthma control
Home visits may improve asthma control

Importance: Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.

Objective: To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.

Design, Setting, and Participants: Randomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King County, Washington

Interventions: The CHWs provided a mean of 4.9 home visits during a 1-year period to assess asthma control, self-management, and home environment and to support asthma self-management practices.
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