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.”