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Shaak S, Brown K, Reichart C, Zimmerman D. Community health workers providing asthma education. J Asthma 2020; 59:572-579. [PMID: 33351650 DOI: 10.1080/02770903.2020.1862184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Children living in urban areas experience disproportionate rates of asthma. Substandard housing conditions in some urban areas contribute to greater exposure to household asthma triggers. This article examines the geographic connection between pediatric asthma and substandard housing in one mid-sized city in Pennsylvania and the effectiveness of a home-based Community Health Worker (CHW) intervention targeted at this high-risk area to improve families' abilities to manage their children's asthma.Methods: The CHWs provided education and resources to families of children diagnosed with mild, moderate or severe persistent asthma. A pre and post-test design was implemented to evaluate if the CHW intervention improved the family's ability to successfully manage their child's asthma. Eighty-one patients completed the program over a six-month period.Results: Results showed significant improvements in the areas of asthma knowledge, fewer missed days of school, fewer days with asthma symptoms, reduction in wheezing and fewer sleep disturbances. There was also a significant decrease in the number of Emergency Department visits and hospital days.Conclusions: By teaching asthma management skills and by addressing in-home triggers, home-based CHW led interventions can be an affordable and effective way for caregivers and children with asthma to improve asthma management.
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Affiliation(s)
- Samantha Shaak
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kimberly Brown
- Department of Pediatrics, Lehigh Valley Reilly Children's Hospital, Allentown, PA, USA
| | - Christine Reichart
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - David Zimmerman
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
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Mundorf C, Shankar A, Peng T, Hassan A, Lichtveld MY. Therapeutic Relationship and Study Adherence in a Community Health Worker-Led Intervention. J Community Health 2018; 42:21-29. [PMID: 27449122 DOI: 10.1007/s10900-016-0220-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Community health workers (CHWs) are increasingly utilized to reach low-resource communities. A critical domain influencing success is the CHWs' ability to create and maintain a therapeutic relationship with the participants they serve. A limited evidence base exists detailing this construct, and evaluating CHW-participant relationships in the context of CHW-led programs. In a longitudinal study design, data on this therapeutic relationship were collected [as captured using The Scale to Assess the Therapeutic Relationship in Community Mental Health Care (STAR)] on 141 participants who had been assigned to a CHW during their perinatal period. Results indicate that therapeutic relationship was associated with the participant's psychosocial health, and independently predicted study adherence in the longitudinal intervention. Changes in therapeutic relationship over the months following birth were strongly associated with changes in anxiety and depression symptoms. A trustful relationship is critical in ensuring CHWs can effectively reach the population they serve. The findings offer additional psychometric evidence of the uses and benefits of STAR outside of the traditional clinical setting in the context of public health research.
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Affiliation(s)
- Christopher Mundorf
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Arti Shankar
- Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Terrance Peng
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Anna Hassan
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Maureen Y Lichtveld
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Abstract
BACKGROUND Adolescents with asthma are at high risk of poor adherence with treatment. This may be compounded by activities that worsen asthma, in particular smoking. Additional support above and beyond routine care has the potential to encourage good self-management. We wanted to find out whether sessions led by their peers or by lay leaders help to reduce these risks and improve asthma outcomes among adolescents. OBJECTIVES To assess the safety and efficacy of lay-led and peer support interventions for adolescents with asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains reports of randomised trials obtained from multiple electronic and handsearched sources, and we searched trial registries and reference lists of primary studies. We conducted the most recent searches on 25 November 2016. SELECTION CRITERIA Eligible studies randomised adolescents with asthma to an intervention led by lay people or peers or to a control. We included parallel randomised controlled trials with individual or cluster designs. We included studies reported as full text, those published as abstract only and unpublished data. DATA COLLECTION AND ANALYSIS Two review authors screened the searches, extracted numerical data and study characteristics and assessed each included study for risk of bias. Primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We graded the analyses and presented evidence in a 'Summary of findings' table.We analysed dichotomous data as odds ratios, and continuous data as mean differences (MD) or standardised mean differences, all with a random-effects model. We assessed clinical, methodological and statistical heterogeneity when performing meta-analyses, and we described skewed data narratively. MAIN RESULTS Five studies including a total of 1146 participants met the inclusion criteria for this review. As ever with systematic reviews of complex interventions, studies varied by design (cluster and individually randomised), duration (2.5 to 9 months), setting (school, day camp, primary care) and intervention content. Most risk of bias concerns were related to blinding and incomplete reporting, which limited the meta-analyses that could be performed. Studies generally controlled well for selection and attrition biases.All participants were between 11 and 17 years of age. Asthma diagnosis and severity varied, as did smoking prevalence. Three studies used the Triple A programme; one of these studies tested the addition of a smoke-free pledge; another delivered peer support group sessions and mp3 messaging to encourage adherence; and the third compared a peer-led asthma day camp with an equivalent camp led by healthcare practitioners.We had low confidence in all findings owing to risk of bias, inconsistency and imprecision. Results from an analysis of asthma-related quality of life based on the prespecified random-effects model were imprecise and showed no differences (MD 0.40, 95% confidence interval (CI) -0.02 to 0.81); a sensitivity analysis based on a fixed-effect model and a responder analysis suggested small benefit may be derived for this outcome. Most other results were summarised narratively and did not show an important benefit of the intervention; studies provided no analysable data on asthma exacerbations or unscheduled visits (data were skewed), and one study measuring adherence reported a drop in both groups. Effects on asthma control favoured the intervention but findings were not statistically significant. Results from two studies with high levels of baseline smoking showed some promise for self-efficacy to stop smoking, but overall nicotine dependence and smoking-related knowledge were not significantly better in the intervention group. Investigators did not report adverse events. AUTHORS' CONCLUSIONS Although weak evidence suggests that lay-led and peer support interventions could lead to a small improvement in asthma-related quality of life for adolescents, benefits for asthma control, exacerbations and medication adherence remain unproven. Current evidence is insufficient to reveal whether routine use of lay-led or peer support programmes is beneficial for adolescents receiving asthma care.Ongoing and future research may help to identify target populations for lay-led and peer support interventions, along with attributes that constitute a successful programme.
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Affiliation(s)
- Kayleigh M Kew
- BMJ Knowledge CentreBritish Medical Journal Technology Assessment Group (BMJ‐TAG)BMA HouseTavistock SquareLondonUKWC1H 9JR
- St George's, University of LondonCochrane Airways, Population Health Research InstituteCranmer TerraceLondonUKSW17 0RE
| | - Robin Carr
- 28 Beaumont Street Medical PracticeOxfordUK
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Lujan J, Ostwald SK, Ortiz M. Promotora Diabetes Intervention for Mexican Americans. DIABETES EDUCATOR 2016; 33:660-70. [PMID: 17684167 DOI: 10.1177/0145721707304080] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this randomized controlled trial is to determine the effectiveness of an intervention led by promotoras (community lay workers) on the glycemic control, diabetes knowledge, and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border. METHODS One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and randomized into 2 groups. Personal characteristics, acculturation, baseline A1C level, diabetes knowledge, and diabetes health beliefs were measured. The intervention was culturally specific and consisted of participative group education, telephone contact, and follow-up using inspirational faith-based health behavior change postcards. The A1C levels, diabetes knowledge, and diabetes health beliefs were measured 3 and 6 months postbaseline, and the mean change between the groups was analyzed. RESULTS The 80% female sample, with a mean age of 58 years, demonstrated low acculturation, income, education, health insurance coverage, and strong Catholicism. No significant changes were noted at the 3-month assessment, but the mean change of the A1C levels, F(1, 148) = 10.28, P < .001, and the diabetes knowledge scores, F(1, 148) = 9.0, P < .002, of the intervention group improved significantly at 6 months, adjusting for health insurance coverage. The health belief scores decreased in both groups. CONCLUSIONS The intervention resulted in decreased A1C levels and increased diabetes knowledge, suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes. Clinical implications and recommendations for future research are suggested.
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Affiliation(s)
| | | | - Melchor Ortiz
- The School of Public Health, University of Texas at Houston, El Paso (Dr Ortiz)
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Rice JL, Matlack KM, Simmons MD, Steinfeld J, Laws MA, Dovey ME, Cohen RT. LEAP: A randomized-controlled trial of a lay-educator inpatient asthma education program. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30006-9. [PMID: 26210342 DOI: 10.1016/j.pec.2015.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/17/2015] [Accepted: 06/23/2015] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To evaluate the impact of LEAP, a volunteer-based, inpatient asthma education program for families of inner-city children with asthma. METHODS 711 children ages 2-17 years admitted with status asthmaticus were randomized to receive usual care or usual care plus a supplemental education intervention. Both groups completed a baseline interview. Trained volunteer lay educators conducted individualized bedside education with the intervention group. Primary outcome was attendance at a post-hospitalization follow-up visit 7-10 days after discharge. Secondary outcomes included parent-reported asthma management behaviors, symptoms, and self-efficacy scores from a one month follow-up interview. RESULTS Post-hospitalization asthma clinic attendance was poor (38%), with no difference between groups. Families randomized to the intervention group were more likely to report use of a controller (OR 2.4, 95% CI 1.3-4.2, p<0.01) and a valved-holding chamber (OR 2.9, 95% CI 1.1-7.4, p=0.03), and were more likely to have an asthma action plan at follow up (OR 2.0, 95% CI 1.3-3.0, p<0.01). Asthma self-efficacy scores were significantly improved among those who received the intervention (p=0.04). CONCLUSIONS Inpatient asthma education by trained lay volunteers was associated with improved asthma management behaviors. PRACTICE IMPLICATIONS This novel volunteer-based program could have widespread implications as a sustainable model for asthma education.
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Affiliation(s)
- Jessica L Rice
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA.
| | - Kristen M Matlack
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Marsha D Simmons
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Jonathan Steinfeld
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Margaret A Laws
- Boston University School of Medicine, Department of Pediatrics, Boston, USA
| | - Mark E Dovey
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Robyn T Cohen
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
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Gutierrez Kapheim M, Ramsay J, Schwindt T, Hunt BR, Margellos-Anast H. Utilizing the Community Health Worker Model to communicate strategies for asthma self-management and self-advocacy among public housing residents. ACTA ACUST UNITED AC 2015. [DOI: 10.1179/1753807615y.0000000011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Matiz LA, Peretz PJ, Jacotin PG, Cruz C, Ramirez-Diaz E, Nieto AR. The impact of integrating community health workers into the patient-centered medical home. J Prim Care Community Health 2014; 5:271-4. [PMID: 24970881 DOI: 10.1177/2150131914540694] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Establishing patient-centered medical homes (PCMHs) that deliver comprehensive care can be challenging for practices serving diverse populations. Integrating community health workers (CHWs) as members of the care team is one approach to deliver such care; however, little is known about this process. We study an approach of integrating CHWs into PCMHs with predominantly Latino, pediatric asthma patients and examine the impact on care delivery. METHODS A case study was conducted to examine the integration of 8 CHWs into 5 PCMHs in an academic medical center located in a large, urban setting. Data associated with referrals to CHW practice-based education and support and to a care coordination program, as well as survey results from providers on the impact of CHWs in PCMHs were collected and analyzed over the study period. RESULTS More than 750 families of children with asthma received education and support from CHWs from February 2011 through December 2013. The number of referrals to the care coordination program increased 7-fold during this time (P < .001). Of providers surveyed (n = 55), those who reported not referring to care coordination decreased from 22% to 6% and those who reported referring patients to care coordination increased from 67% to 79%. Additionally, 39% of providers reported giving a care plan to patients when prompted by the CHW. CONCLUSIONS CHWs can be successfully integrated into the PCMH care team. They may also impact the identification of high-risk populations for care coordination and delivery of comprehensive care.
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Affiliation(s)
| | | | | | - Carmen Cruz
- NewYork Presbyterian Hospital, New York, NY, USA
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Parab CS, Cooper C, Woolfenden S, Piper SM. Specialist home-based nursing services for children with acute and chronic illnesses. Cochrane Database Syst Rev 2013; 2013:CD004383. [PMID: 23771694 PMCID: PMC7207262 DOI: 10.1002/14651858.cd004383.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review is an update of our original review, which was published in 2006. OBJECTIVES To evaluate specialist home-based nursing services for children with acute and chronic illnesses. SEARCH METHODS We searched the following databases in February 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012 Issue 2, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and Sociological Abstracts. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) of children from birth to age 18 years with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional health care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. DATA COLLECTION AND ANALYSIS Two review authors extracted data from the studies independently and resolved any discrepancies by recourse to a third author. Meta-analysis was not appropriate because of the clinical diversity of the studies and the lack of common outcome measures. MAIN RESULTS We screened 4226 titles to yield seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported a reduction in the hospital stay with no difference in the hospital readmission rates. Three studies reported a reduction in parental anxiety and improvement in child behaviours was reported in three studies. Overall increased parental satisfaction was reported in three studies. Also, better parental coping and family functioning was reported in one study. By contrast, one study each reported no impact on parental burden of care or on functional status of children. Home care was reported as more costly for service providers with substantial cost savings for the family in two studies, while one study revealed no significant cost benefits for the family. AUTHORS' CONCLUSIONS Current research does not provide supporting evidence for a reduction in access to hospital services or a reduction in hospital readmission rate for children with acute and chronic illnesses using specialist home-based nursing services; however, the only summary finding across a few studies was that there is a significant decrease in length of hospitalisation. The preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home-based care. Further trials are required, measuring health, satisfaction, service utilisation and long-term costs.
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Affiliation(s)
- Chitra S Parab
- Illawarra Shoalhaven Diagnostic & Assessment Service, Illawarra Shoalhaven Local Health District, North Wollongong, Australia.
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Nelson KA, Highstein G, Garbutt J, Trinkaus K, Smith SR, Strunk RC. Factors associated with attaining coaching goals during an intervention to improve child asthma care. Contemp Clin Trials 2012; 33:912-9. [PMID: 22664649 DOI: 10.1016/j.cct.2012.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/13/2012] [Accepted: 05/13/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine parent and child characteristics associated with engagement in a coaching intervention to improve pediatric asthma care and factors associated with readiness to adopt and maintain targeted asthma management behaviors. METHODS Using methods based on the Transtheoretical Model, trained lay coaches worked with 120 parents of children with asthma promoting adoption and maintenance of asthma management strategies (behaviors). Coaches assigned stage-of-change (on continuum: pre-contemplation, contemplation, preparation, action, maintenance) for each behavior every time it was discussed. Improvement in stage-of-change was analyzed for association with characteristics of the participants (parents and children) and coaching processes. RESULTS Having more coach contacts was associated with earlier first contact (p<0.001), fewer attempts per successful contact (p<0.001), prior asthma hospitalization (p=0.021), more intruding events (p<0.001), and less social support (p=0.048). In univariable models, three factors were associated with forward movement at least one stage for all three behaviors: more coach contacts overall, fewer attempts per successful contact, and more discussion/staging episodes for the particular behavior. In multivariable models adjusting for characteristics of participants and coaching process, the strongest predictor of any forward stage movement for each behavior was having more contacts (p<0.05). CONCLUSIONS Improvement in readiness to adopt and maintain asthma management behaviors was mostly associated with factors reflecting more engagement of participants in the program. Similar coaching interventions should focus on early and frequent contacts to achieve intervention goals, recognizing that parents of children with less severe disease and who have more social support may be more difficult to engage.
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Affiliation(s)
- Kyle A Nelson
- Pediatric Emergency Medicine, The Children's Hospital of Boston, Boston, MA, USA.
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Margellos-Anast H, Gutierrez MA, Whitman S. Improving asthma management among African-American children via a community health worker model: findings from a Chicago-based pilot intervention. J Asthma 2012; 49:380-9. [PMID: 22348448 DOI: 10.3109/02770903.2012.660295] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods. METHODS Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. RESULTS Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention. CONCLUSIONS Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.
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Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, Hopkins DP, Lawrence BM, Sipe TA. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review. Am J Prev Med 2011; 41:S5-32. [PMID: 21767736 DOI: 10.1016/j.amepre.2011.05.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/25/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Asthma exacerbations are commonly triggered by exposure to allergens and irritants within the home. The purpose of this review was to evaluate evidence that interventions that target reducing these triggers through home visits may be beneficial in improving asthma outcomes. The interventions involve home visits by trained personnel to conduct two or more components that address asthma triggers in the home. Intervention components focus on reducing exposures to a range of asthma triggers (allergens and irritants) through environmental assessment, education, and remediation. EVIDENCE ACQUISITION Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. The literature search identified over 10,800 citations. Of these, 23 studies met intervention and quality criteria for inclusion in the final analysis. EVIDENCE SYNTHESIS In the 20 studies targeting children and adolescents, the number of days with asthma symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to 21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year); school days missed were reduced by 12.3 days per year (range of values: reduction of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits per year). Only three studies reported outcomes among adults with asthma, finding inconsistent results. CONCLUSIONS Home-based, multi-trigger, multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma. The effectiveness of these interventions in adults is inconclusive due to the small number of studies and inconsistent results. Additional studies are needed to (1) evaluate the effectiveness of these interventions in adults and (2) determine the individual contributions of the various intervention components.
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Affiliation(s)
- Deidre D Crocker
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia 30333, USA
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Lob SH, Boer JH, Porter PG, Núñez D, Fox P. Promoting best-care practices in childhood asthma: quality improvement in community health centers. Pediatrics 2011; 128:20-8. [PMID: 21669890 DOI: 10.1542/peds.2010-1962] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Outpatient asthma management remains suboptimal. We previously reported significant improvements in asthma guideline adherence and outcomes in children by using quality-improvement processes and community health workers. We hypothesized that a larger project could achieve comparable outcome improvements with streamlined quality-improvement processes and decreased technical assistance. METHODS Seventeen clinics treating 12 000 children with asthma were evaluated through interviews of a subset of patients with persistent or high-risk asthma (n=761) at baseline and at 12 and 21 months and chart reviews randomly selected from all patients with asthma at baseline and 12 and 24 months (n=2040). Multidisciplinary teams developed data-driven continuous quality-improvement activities. Asthma coordinators provided patient education and were active team members. RESULTS Study children were predominantly Hispanic (77%) and black (11%); 60% were enrolled in Medicaid, and 9% were uninsured. Comparing results between baseline and the 21-month follow-up, significantly fewer families reported emergency-department visits (29.6% vs 9.3%), hospitalizations (10.9% vs 3.4%), frequent daytime symptoms (44.0% vs 11.7%), and missed school days (28.7% vs 13.6%); significantly more reported confidence in asthma management (70.6% vs 95.5%); and quality-of-life scores increased significantly for both children and caregivers (all P<.05). Cross-sectional data revealed significant clinic-wide improvements in symptom documentation, health care use, and review of action plans. CONCLUSIONS On a larger scale, this approach realized impressive changes in provider clinical practice associated with major improvements in health outcomes. It holds great potential for significantly reducing asthma-related morbidity among low-income children.
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Affiliation(s)
- Sibylle H Lob
- Institute for Health and Aging, University of California, San Francisco, 3333 California St, San Francisco, CA 94143-0646, USA
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Abstract
Asthma is among the most common chronic childhood diseases, affecting 6.8 million children nationwide. The highest rates of morbidity and mortality associated with the disease occur among those living in the inner city. Because asthma is a complex disease affected by physiological, social, environmental, and behavioral factors, interventions to reduce its morbidity burden need to address multiple determinants of health. In response to this need, the Centers for Disease Control and Prevention developed a multisite cooperative agreement for the Controlling Asthma in American Cities Project (CAAC), with the primary goal of developing innovative, effective community-based interventions. All CAAC sites found a need for family and home asthma services (FHAS) and developed multicomponent (e.g., asthma self-management, social services, coordinated care) and multitrigger environmental interventions. This paper presents a synthesis of key program variables and process indicators for six CAAC FHAS interventions for consideration by communities, coalitions, or programs planning to implement similar activities.
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Krieger J, Takaro TK, Song L, Beaudet N, Edwards K. A randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers: the Seattle-King County Healthy Homes II Project. ACTA ACUST UNITED AC 2009; 163:141-9. [PMID: 19188646 DOI: 10.1001/archpediatrics.2008.532] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses. DESIGN Randomized controlled trial. SETTING Community and public health clinics and homes. PARTICIPANTS Three hundred nine children aged 3 to 13 years with asthma living in low-income households. INTERVENTIONS All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources. OUTCOME MEASURES Asthma symptom-free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. RESULTS Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3-0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4-0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5-2.1; nurse + CHW: 1.9 days; 95% CI, 1.1-2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%-27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%-32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00-0.44; P = .049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02-1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant. CONCLUSION The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life.
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Affiliation(s)
- James Krieger
- University of Washington School of Medicine and School of Public Health and Community Medicine, Seattle, WA 98104, USA.
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Martin MA, Catrambone CD, Kee RA, Evans AT, Sharp LK, Lyttle C, Rucker-Whitaker C, Weiss KB, Shannon JJ. Improving asthma self-efficacy: developing and testing a pilot community-based asthma intervention for African American adults. J Allergy Clin Immunol 2009; 123:153-159.e3. [PMID: 19130936 PMCID: PMC2675162 DOI: 10.1016/j.jaci.2008.10.057] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 10/23/2008] [Accepted: 10/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-income African American adults in Chicago have disproportionately high asthma morbidity and mortality rates. Interventions that improve asthma self-efficacy for appropriate self-management behaviors might ultimately improve asthma control in this population. OBJECTIVE We sought to pilot test an intervention to improve asthma self-efficacy for appropriate self-management behaviors. METHODS Participants for this trial were recruited through 2 primary care clinics located in the largest African American community in Chicago. Participants were then randomized into one of 2 groups. The control group received mailed asthma education materials. The intervention group was offered 4 group sessions led by a community social worker and 6 home visits by community health workers. Telephone interviews were conducted at baseline (before intervention), 3 months (after intervention), and 6 months (maintenance). RESULTS The 42 participants were predominantly African American and low income and had poorly controlled persistent asthma. The intervention group had significantly higher asthma self-efficacy at 3 months (P < .001) after the completion of the intervention. Asthma action plans were more common in the intervention group at 3 months (P = .06). At 6 months, the intervention group had improved asthma quality of life (P = .002) and improved coping (P = .01) compared with control subjects. Trends in behavioral and clinical outcomes favored the intervention group but were not statistically significant. CONCLUSIONS This community-based asthma intervention improved asthma self-efficacy, self-perceived coping skills, and asthma quality of life for low-income African American adults. Larger trials are needed to test the efficacy of this intervention to reduce asthma morbidity in similar high-risk populations.
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Affiliation(s)
- Molly A Martin
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
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Mahat G, Scoloveno MA, De Leon T, Frenkel J. Preliminary evidence of an adolescent HIV/AIDS peer education program. J Pediatr Nurs 2008; 23:358-63. [PMID: 18804016 DOI: 10.1016/j.pedn.2007.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/27/2007] [Indexed: 11/17/2022]
Abstract
Adolescent peer education has been found to be an effective method to improve adolescents' knowledge and positive health behaviors. The purpose of this study was to determine the extent to which a peer education program was effective in changing adolescents' HIV/AIDS knowledge, risk behavior intentions, and confidence to engage in safe sex. The results showed that there was a significant difference in HIV knowledge between the peer education group and the traditionally educated group, with the peer group demonstrating greater knowledge. There was no significant difference in confidence to engage in safe sex between the two groups, but students in the intervention group were more likely to engage in safe sex than students in the traditionally educated group. Nurses can provide leadership in the development, implementation, and evaluation of peer education in adolescent health.
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Affiliation(s)
- Ganga Mahat
- Rutgers, the State University of New Jersey, College of Nursing, Newark, NJ 07102, USA.
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Bryant-Stephens T, Li Y. Outcomes of a home-based environmental remediation for urban children with asthma. J Natl Med Assoc 2008; 100:306-16. [PMID: 18390024 DOI: 10.1016/s0027-9684(15)31243-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT Increasing urban asthma prevalence and severity is found among minority, underserved populations. Improving asthma self-management includes home management of complex medical protocols as well as environmental trigger removal. OBJECTIVE To study the effectiveness of a low-cost approach to improve control of asthma symptoms in an urban population through lay educators who promote a generalized approach to asthma trigger avoidance in the bedrooms of children with asthma. DESIGN AND PATIENTS Prospective, randomized controlled trial with two arms: historical controls and matched controls for each subject. SUBJECTS Two-hundred-eighty-one patients living in an urban environment, randomized to receive home visits only (n = 128) or home visits with environmental remediation (n = 153). One-hundred-fifteen controls matched according to age, gender and ethnicity did not receive any intervention. INTERVENTIONS In-home education visits covered asthma physiology, asthma trigger avoidance and asthma management. Environmental remediation was conducted together with the caregiver. OUTCOMES Primary outcomes include length of hospital stay, number of emergency visits and number of sick visits. Secondary outcomes are symptom frequency, medication management and trigger reduction. RESULTS Both intervention groups experienced reduction of hospitalizations, emergency room visits, sick visits and asthma symptoms. Both groups showed outcomes significantly superior to the matched control group. Intervention effectively reduced the presence of rodents and carpet in home and increased the use of mattress and pillow covers. CONCLUSIONS This study shows that low-cost in-home education and environmental remediation improve outcomes for children with asthma. Lay educators can deliver effective asthma-specific education that results in improved asthma control.
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Affiliation(s)
- Tyra Bryant-Stephens
- Department of Pediatrics and Community Asthma Prevention Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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18
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Persky V, Turyk M, Piorkowski J, Coover L, Knight J, Wagner C, Hernandez E, Eldeirawi K, Fitzpatrick A. Inner-city asthma: the role of the community. Chest 2008; 132:831S-839S. [PMID: 17998347 DOI: 10.1378/chest.07-1911] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Asthma morbidity and mortality are disproportionately high in low-income minority populations. Variations in environmental exposures, stress, and access to appropriate health care all contribute to these disparities. The complex nature of asthma with strong contributions from environmental, psychosocial, and biological factors suggest that community-based approaches focused on the unique needs of high-risk populations may be effective. The few previous randomized trials suggest that case management with professionals and/or community health educators may reduce asthma morbidity. Health-educator programs should be lodged in stable infrastructures with training and funding for community health workers to obtain long-term sustainability. Factors not amenable to individual intervention, however, such as poor condition of homes, outdoor pollution, and lack of access to appropriate care, will require collaborative efforts of community groups, academic professionals, public agencies, and health-care providers.
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Affiliation(s)
- Victoria Persky
- Epidemiology/Biostatistics Division, University of Illinois School of Public Health, 1603 Taylor St, Room 878a, Chicago, IL 60612, USA.
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19
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Fox P, Porter PG, Lob SH, Boer JH, Rocha DA, Adelson JW. Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies. Pediatrics 2007; 120:e902-11. [PMID: 17908746 DOI: 10.1542/peds.2006-1805] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to improve asthma-related health outcomes in an ethnically and geographically disparate population of economically disadvantaged school-aged children by using a team-based approach using continuous quality improvement and community health workers. PATIENTS AND METHODS A demonstration project was conducted with 7 community clinics treating approximately 3000 children with asthma 5 to 18 years of age. The overall clinic population with asthma was assessed for care-process changes through random cross-sectional chart reviews at baseline and 24 months (N = 560). A subset of patients with either moderate or severe persistent asthma or poorly controlled asthma (N = 405) was followed longitudinally for specific asthma-related clinical outcomes, satisfaction with care, and confidence managing asthma by family interview at baseline and at 12 or 24 months. Patient-centered and care-process outcomes included patient/parent assessment of quality of care and confidence in self-management, asthma action plan review, and documentation of guideline-based indicators of quality of care. Direct clinical outcomes included daytime and nighttime symptoms, use of rescue medications, acute care and emergency department visits, hospitalizations, and missed school days. Each clinic site's degree of adherence to the intervention model was evaluated and ranked to examine the correlation between model adherence and outcomes. RESULTS Cross-sectional data showed clinic-wide improvements in the documentation of asthma severity, review of action plans, health services use, and asthma symptoms. At follow-up in the longitudinal sample, fewer patients reported acute visits, emergency department visits, hospitalizations, frequent daytime and nighttime symptoms, and missed school days compared with baseline. More patients reported excellent or very good quality of care and confidence in asthma self-management. Linear regression analysis of the clinical sites' model adherence ranks against site-level combined scores estimating overall outcomes, clinical outcomes, and improvements in clinical care processes showed significant linear correlations with R2 > or = 0.60. CONCLUSIONS The demonstration produced major improvements in asthma-related care processes and clinical outcomes. Closer adherence to the demonstration model was directly associated with better outcomes.
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Affiliation(s)
- Patrick Fox
- Institute for Health & Aging, University of California, 3333 California St, San Francisco, CA 94118, USA
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20
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Karnick P, Margellos-Anast H, Seals G, Whitman S, Aljadeff G, Johnson D. The pediatric asthma intervention: a comprehensive cost-effective approach to asthma management in a disadvantaged inner-city community. J Asthma 2007; 44:39-44. [PMID: 17365203 DOI: 10.1080/02770900601125391] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare three pediatric asthma interventions for their impact on improving the health status of inner-city asthmatic children and in achieving cost savings. STUDY DESIGN A total of 212 children 1 to 16 years of age were randomized into three groups: group 1 (n = 74) received one individualized asthma education session; group 2 (n = 68) received reinforced asthma education; group 3 (n = 70) received reinforced asthma education plus case management. Asthma-related health resource utilization and cost were primary outcomes. The cost-benefit analysis sought to estimate the expected cost savings to the Illinois Department of Healthcare and Family Services (Medicaid administrator) associated with the intervention. RESULTS Participants in all three groups used significantly fewer emergency health care services in the follow-up year. Averaged across all three groups, the magnitudes of declines were substantial: 81% for hospitalizations, 69% for hospital days, 64% for emergency department visits, and 58% for clinic visits. Although there were no statistically significant differences between study groups for three of the four main outcome measures, group 3 participants consistently improved to the greatest degree. All three interventions were associated with considerable cost savings ranging from $4,021/child/year for group 1 to $4,503/child/year for group 3. CONCLUSION Asthma education with or without case management services enhances the health of children with asthma thereby reducing associated costs.
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Affiliation(s)
- Paula Karnick
- Sinai Children's Hospital. Chicago, Illinois 60608, USA
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21
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Mosnaim G, Kohrman C, Sharp LK, Wolf ME, Sadowski LS, Ramos L, Grammer LC. Coping with asthma in immigrant Hispanic families: a focus group study. Ann Allergy Asthma Immunol 2006; 97:477-83. [PMID: 17069102 DOI: 10.1016/s1081-1206(10)60938-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about how childhood asthma affects immigrant Hispanic families in the United States. Qualitative research is effective for understanding the social, cultural, functional, and structural aspects of asthma in the family context. Furthermore, such knowledge is necessary to develop culturally appropriate interventions for these families. OBJECTIVES To describe participants' perceptions of their roles in caring for an asthmatic child, to compare family patterns of caring for an asthmatic child by parents' country of origin, to identify barriers to caring for an asthmatic child, and to evaluate specific coping needs of low-income immigrant Hispanic families caring for an asthmatic child. METHODS Five focus groups were conducted with low-income, immigrant, Spanish-speaking Hispanic adults caring for an asthmatic child, including community health workers, mothers, fathers, and grandparents, along with women with asthma. Audiotaped focus groups were transcribed verbatim in Spanish, forward translated into English, and back translated into Spanish. Data analysis was performed using qualitative analytic methods. RESULTS Forty-one participants represented a range of countries of origin. Different themes emerged for community health workers vs parents and grandparents and for women vs men caring for a child with asthma. All the participants reported strong beliefs in using folk medicines. Barriers identified included language, culture, poverty, lack of health insurance, and poor living conditions. CONCLUSIONS Results highlight the lack of asthma self-management skills, diagnostic uncertainty, and the use of folk medicine as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in this vulnerable population.
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Affiliation(s)
- Giselle Mosnaim
- Department of Immunology and Microbiology, Rush Medical College, Chicago, Illinois 60612, USA.
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22
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Cooper C, Wheeler DM, Woolfenden SR, Boss T, Piper S. Specialist home-based nursing services for children with acute and chronic illnesses. Cochrane Database Syst Rev 2006:CD004383. [PMID: 17054202 DOI: 10.1002/14651858.cd004383.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing trauma resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. OBJECTIVES To evaluate specialist home-based nursing services for children with acute and chronic illnesses. SEARCH STRATEGY Electronic searches were made of CENTRAL (Cochrane Central Register of Controlled Trials) 2005 (Issue 2); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); PsycINFO (1887 to August 2005); CINAHL (1982 to August 2005); Sociological Abstracts (1963 to August 2005). Optimally sensitive search strategies for randomised controlled trials (RCTs) were combined with medical subject headings and text words specific for ambulatory paediatrics, nursing outreach and 'hospital in the home', and no language restrictions were applied. SELECTION CRITERIA RCTs of children aged 0-18 with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional medical care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. DATA COLLECTION AND ANALYSIS Meta-analysis was not appropriate because of the clinical diversity and lack of common outcomes measures MAIN RESULTS 1655 titles yielded 5 RCTs with a total of 771 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported improvements in child and parental anxiety; one study reported no significant difference in readmissions; two studies reported significantly fewer bed days; increased satisfaction was reported ; home care was more costly for service providers, but less expensive for parents. AUTHORS' CONCLUSIONS While current research does not provide definitive support for specialist home-based nursing services in reducing access to hospital services or length of stay, preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home-based care. Further trials are required, measuring health, satisfaction, service utilisation and long-term costs.
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Affiliation(s)
- C Cooper
- Fairfield Health Service, P.O. Box 5, Fairfield, New South Wales, Australia.
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Friedman AR, Butterfoss FD, Krieger JW, Peterson JW, Dwyer M, Wicklund K, Rosenthal MP, Smith L. Allies community health workers: Bridging the gap. Health Promot Pract 2006; 7:96S-107S. [PMID: 16636160 DOI: 10.1177/1524839906287065] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allies Against Asthma coalitions each employ a community health worker (CHW) program as part of its community action plan. The structure and management of CHW programs vary in response to the resources and needs of the local community, as do the roles and characteristics of the CHWs hired. All programs utilize CHWs to provide community-based education and/or outreach to community members, primarily in their homes. Using an asthma action plan, most Allies CHW programs function as an extension of and link to the clinician, providing basic asthma education and care coordination in a supportive, family-friendly setting, context, and location. Community health workers rely heavily on relationship building and family empowerment to assist families in improving asthma control. Working within a coalition framework helps integrate the CHW program into other services and resources in the community. As participants in coalition activities, CHWs often bring an important and meaningful viewpoint to the coalition.
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Affiliation(s)
- Amy R Friedman
- Allies Against Asthma, Center for Managing Chronic Disease at the University of Michigan School of Public Health in Ann Arbor, Michigan, USA
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24
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Martin MA, Hernández O, Naureckas E, Lantos J. Reducing home triggers for asthma: the Latino community health worker approach. J Asthma 2006; 43:369-74. [PMID: 16801141 DOI: 10.1080/02770900600709781] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed the ability of a community health worker asthma intervention to change home asthma triggers. A total of 56 children and 47 adults with asthma were enrolled. Home trigger scores for the children averaged 2.8 at the initial home visit and then 2.3, 2.1, and 2.0 at 3, 6, and 12 months. Home trigger scores for the adults showed a similar trend. Every home visit was associated with a 0.32 reduction in home trigger score (p < 0.01) for children and a 0.41 reduction (p < 0.01) for adults. This intervention shows promise as a way to reduce asthma triggers in urban low-income Latino communities.
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25
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Primomo J, Johnston S, DiBiase F, Nodolf J, Noren L. Evaluation of a community-based outreach worker program for children with asthma. Public Health Nurs 2006; 23:234-41. [PMID: 16684201 DOI: 10.1111/j.1525-1446.2006.230306.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE An asthma outreach worker (AOW) can provide home-based education about asthma management and methods to minimize home environmental asthma triggers. A theory-based AOW program was implemented by a community partnership and its effectiveness was evaluated. DESIGN Baseline and follow-up surveys were used to evaluate the effectiveness of the AOW. SAMPLE The convenience sample consisted of 60 caregivers whose children received AOW services. MEASURES Quality of life, use of asthma management plans, medication use, health care utilization, home environmental behavior changes to reduce triggers, and satisfaction with AOW services were self-reported by caregivers. RESULTS Caregivers reported significantly higher quality of life at follow-up than at baseline. At follow-up, 93% of the children had asthma management plans as compared with 31% at baseline. Self-reported hospitalizations were significantly reduced. All of the families made changes to minimize household asthma triggers. Caregivers reported high satisfaction with the AOW and 90% of them felt that the home environmental assessment conducted by the AOW helped improve their child's asthma. CONCLUSION Short-term community-based AOW services for children can be effective in enhancing self-management capabilities, improving the quality of life, increasing the use of asthma management plans, and helping families reduce asthma triggers in the home environment.
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Affiliation(s)
- Janet Primomo
- Tacoma Nursing Program, University of Washington, Tacoma, Washington 98402, USA.
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26
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Martin M, Hernández O, Naureckas E, Lantos J. Improving asthma research in an inner-city Latino neighborhood with community health workers. J Asthma 2006; 42:891-5. [PMID: 16393730 DOI: 10.1080/02770900500371443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.
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Affiliation(s)
- Molly Martin
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
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27
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Boudreaux ED, Clark S, Camargo CA. Telephone follow-up after the emergency department visit: experience with acute asthma. Ann Emerg Med 2005; 35:555-563. [PMID: 28140260 DOI: 10.1016/s0196-0644(00)70027-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/1999] [Revised: 01/25/2000] [Accepted: 02/08/2000] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This study explored how a variety of demographic and illness-related factors were associated with telephone follow-up among patients visiting the emergency department for acute asthma. METHODS We performed a prospective cohort study as part of the Multicenter Airway Research Collaboration (MARC). The study was performed at 77 EDs in 22 US states and 4 Canadian provinces. ED patients, ages 2 to 54 years, who presented with acute asthma underwent a structured interview during their visit. Two weeks later, research personnel attempted to contact participants by telephone, using numbers obtained during the ED interview. RESULTS A total of 1,847 adult and 1,184 pediatric patients were interviewed in the ED. Of these, 1,308 (71%) adult patients and 1,026 (87%) pediatric patients were successfully reached for 2-week telephone follow-up. Multivariate analyses revealed the factor most strongly related to contact was age, with pediatric patients being 2.5 times more likely to be reached than adults (95% confidence interval 2.0 to 3.2). Also, participants who were black, low in socioeconomic status, lacking a primary care provider, and exposed to tobacco smoke were significantly less likely to have been reached (all P <.001). CONCLUSION In contrast to some reports in the literature, telephone contact rates were high. However, successful contact was not equally likely among all patient groups. Although the high contact rates support the feasibility of telephone follow-up of asthmatic patients visiting the ED, the results also act as a reminder of the potential biases that may arise when using telephone contact for clinical, quality assurance, and research reasons. [Boudreaux ED, Clark S, Camargo CA Jr, on behalf of the MARC Investigators. Telephone follow-up after the emergency department visit: experience with acute asthma. Ann Emerg Med. June 2000;35:555-563.].
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Affiliation(s)
- Edwin D Boudreaux
- From the Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA(*); the Department of Emergency Medicine, Massachusetts General Hospital,(‡) and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,(§) Boston, MA
| | - Sunday Clark
- From the Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA(*); the Department of Emergency Medicine, Massachusetts General Hospital,(‡) and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,(§) Boston, MA
| | - Carlos A Camargo
- From the Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA(*); the Department of Emergency Medicine, Massachusetts General Hospital,(‡) and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,(§) Boston, MA
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Krieger JW, Takaro TK, Song L, Weaver M. The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. Am J Public Health 2005; 95:652-9. [PMID: 15798126 PMCID: PMC1449237 DOI: 10.2105/ajph.2004.042994] [Citation(s) in RCA: 288] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers. METHODS We conducted a randomized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4-12 years who had asthma. Community health workers provided in-home environmental assessments, education, support for behavior change, and resources. Participants were assigned to either a high-intensity group receiving 7 visits and a full set of resources or a low-intensity group receiving a single visit and limited resources. RESULTS The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P=.138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were 189-721 dollars. CONCLUSIONS Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.
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Affiliation(s)
- James W Krieger
- Public Heath-Seattle and King County, 999 Third Avenue, Suite 1200, Seattle, WA 98104, USA.
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29
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Velsor-Friedrich B, Pigott T, Srof B. A practitioner-based asthma intervention program with African American inner-city school children. J Pediatr Health Care 2005; 19:163-71. [PMID: 15867832 DOI: 10.1016/j.pedhc.2004.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Asthma is the most prevalent chronic illness, affecting more than 7 million children younger than 17 years. Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years, particularly in minority populations. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma. METHOD The intervention consisted of participation in an asthma education program (Open Airways) followed by 5 monthly visits with a nurse practitioner. The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group. RESULTS Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge, asthma self-efficacy, general self-care practices, and asthma self-care practices. No significant differences were found between the two groups on health outcomes. DISCUSSION A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma. Recommendations for future research and clinical practice are discussed.
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Johnson RE, Green BL, Anderson-Lewis C, Wynn TA. Community health advisors as research partners: an evaluation of the training and activities. FAMILY & COMMUNITY HEALTH 2005; 28:41-50. [PMID: 15625505 DOI: 10.1097/00003727-200501000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The feasibility of training large numbers of community health advisors as research partners (CHARPs) was evaluated using talking circles data and cancer activity questionnaires and logs. The talking circles data indicated that the CHARPs (n=108) valued their training and believed they learned necessary research partner skills. A review of contacts (n=7,956) provided evidence that CHARPs (n=883) could work as a team to deliver a variety of services over time to the community. The findings suggested that implementing a large scale intervention with CHARPs has the potential to increase the dissemination of cancer information and to reduce cancer disparities.
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Affiliation(s)
- Rhoda E Johnson
- Department of Women's Studies, The University of Alabama, Tuscaloosa, 35487-0272, USA.
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31
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Forst L, Lacey S, Chen HY, Jimenez R, Bauer S, Skinner S, Alvarado R, Nickels L, Zanoni J, Petrea R, Conroy L. Effectiveness of community health workers for promoting use of safety eyewear by Latino farm workers. Am J Ind Med 2004; 46:607-13. [PMID: 15551366 DOI: 10.1002/ajim.20103] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To evaluate The Community Health Worker "promotor de salud" (CHW) model is evaluated as a tool for reducing eye injuries in Latino farm workers. METHODS In 2001, 786 workers on 34 farms were divided into three intervention blocks: (A) CHWs provided protective eyewear and training to farm workers; (B) CHWs provided eyewear but no training to farm workers; (C) eyewear was distributed to farm workers with no CHW present and no training. RESULTS Pre- and post-intervention questionnaires demonstrated greater self-reported use of eyewear in all blocks after the intervention (P < 0.0001), with Block A showing the greatest change compared to B (P < 0.0001) and C (P = 0.03); this was supported by field observations. Block A showed the greatest improvement in knowledge on questions related to training content. CONCLUSION CHWs were an effective tool to train farm workers in eye health and safety, improving the use of personal protective equipment and knowledge.
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Affiliation(s)
- Linda Forst
- University of Illinois at Chicago School of Public Health, Chicago, Illinois 60612, USA.
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Shin S, Furin J, Bayona J, Mate K, Kim JY, Farmer P. Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience. Soc Sci Med 2004; 59:1529-39. [PMID: 15246180 DOI: 10.1016/j.socscimed.2004.01.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Programs implementing community-based directly observed therapy (DOT) have demonstrated success in the treatment of patients with tuberculosis. However, given complexities in the management and treatment of patients infected with multidrug-resistant tuberculosis (MDR-TB), the utilization of community-based DOT to treat MDR-TB patients has only recently been successfully attempted. We describe the first such program and highlight the crucial components and most critical challenges to creating a successful community-based MDR-TB treatment program.
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Affiliation(s)
- Sonya Shin
- Division of Social medicine and Health Inequalities, Brigham and Women's Hospital, 1620 Tremont St 3rd Floor, Boston, MA 02120-1613, USA.
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Schulte A, Musolf J, Meurer JR, Cohn JH, Kelly KJ. Pediatric asthma case management: a review of evidence and an experimental study design. J Pediatr Nurs 2004; 19:304-10. [PMID: 15308981 DOI: 10.1016/j.pedn.2004.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.
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Affiliation(s)
- Amanda Schulte
- Center for the Advancement of Urban Children, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital and Health System, Milwaukee, USA.
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Lewis TC, Stout JW, Martinez P, Morray B, White LC, Heckbert SR, Redding GJ. Prevalence of asthma and chronic respiratory symptoms among Alaska Native children. Chest 2004; 125:1665-73. [PMID: 15136374 DOI: 10.1378/chest.125.5.1665] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students. DESIGN School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms. SETTING The Yukon-Kuskokwim delta region of western Alaska. PARTICIPANTS A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children). INTERVENTIONS No study intervention. RESULTS Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children. CONCLUSIONS Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Fisher EB, Strunk RC, Sussman LK, Sykes RK, Walker MS. Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Coalition. Pediatrics 2004; 114:116-23. [PMID: 15231917 DOI: 10.1542/peds.114.1.116] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low-income African Americans exhibit disproportionate prevalences, morbidity rates, and mortality rates for asthma. OBJECTIVE To determine whether a community-based intervention, the Neighborhood Asthma Coalition (NAC), conducted through a well-established neighborhood organization in St. Louis could improve awareness of asthma, change attitudes about its care, improve asthma management practices, and reduce the need for acute care for asthma. METHODS The NAC included educational programs for parents and children, promotional activities, and individualized support provided by trained neighborhood residents. African American children, 5 to 14 years of age, with at least 1 incident of acute care (emergency department visit or hospitalization) within the previous year were enrolled from 8 zip code areas with low-income residents and high proportions of Medicaid-eligible children, ie, 4 NAC neighborhoods and 4 comparable control neighborhoods. Evaluations included quarterly telephone interviews to assess asthma attitudes and management and sites of care. Audits of acute care sites covered 12 months before initiation of the NAC through 3 years of the program. RESULTS A total of 371 patients were contacted and determined to be eligible for the study, and 345 agreed to participate, representing a recruitment rate of 93%. Of those, 15 withdrew and 24 were lost to follow-up monitoring after the initial contact. In addition, 57 were excluded from analysis because of relocation or for other reasons. Utilization data to determine rates of acute care (emergency department visits and hospitalizations) were collected for 249 patients (100 NAC subjects and 149 control subjects). Acute care rates decreased for both the NAC and control groups from the year before intervention to the last year of intervention, with no significant differences between the NAC and control groups. Participation in NAC programming affected the acute care outcome; the NAC-low participation and control groups did not differ but the NAC-high participation group differed significantly from the pooled control and NAC-low participation groups in reductions in acute care rates. Both contacts with NAC staff members and attendance at educational events were associated with changes toward stronger views that asthma can be managed (partial correlation = .27 and partial correlation = .24, respectively). Structural equation modeling demonstrated that participation in the NAC was associated with positive changes on the Index of Asthma Attitudes scale and lower rates of acute care. Social isolation was associated with greater participation in the program and thus reduced care rates. CONCLUSIONS The NAC reached its intended audience, including those who were socially isolated, brought about changes in management practices, and was associated with promising reductions in acute care rates among active participants in the program.
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Affiliation(s)
- Edwin B Fisher
- Department of Psychology, Washington University, St Louis, Missouri 63108, USA
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Boudreaux ED, Emond SD, Clark S, Camargo CA. Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status. Chest 2003; 124:803-12. [PMID: 12970001 DOI: 10.1378/chest.124.3.803] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES). DESIGN Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge. PARTICIPANTS Sixty-four North American EDs. RESULTS A total of 1,847 patients were enrolled into the study. Black and Hispanic asthma patients had a history of more hospitalizations than did whites (ever-hospitalized patients: black, 66%; Hispanic, 63%; white, 54%; p < 0.001; patients hospitalized in the past year: black, 31%; Hispanic, 33%; white, 25%; p < 0.05) and more frequent ED use (median use in past year: black, three visits; Hispanic, three visits; white, one visit; p < 0.001). The mean initial peak expiratory flow rate (PEFR) was lower in blacks and Hispanics (black, 47%; Hispanic, 47%; white, 52%; p < 0.001). For most factors, ED management did not differ based on race/ethnicity. After accounting for several confounding variables, blacks and Hispanics were twice as likely to be admitted to the hospital. Blacks and Hispanics also were more likely to report continued severe symptoms 2 weeks after hospital discharge (blacks, 24%; Hispanic, 31%; white, 19%; p < 0.01). After adjusting for sociodemographic factors, the race/ethnicity differences in initial PEFR and posthospital discharge symptoms were markedly reduced. CONCLUSION Despite significant racial/ethnic differences in chronic asthma severity, initial PEFR at ED presentation, and posthospital discharge outcome, ED management during the index visit was fairly similar for all racial groups. SES appears to account for most of the observed acute asthma differences, although hospital admission rates were higher among black and Hispanic patients after adjustment for confounding factors. Despite asthma treatment advances, race/ethnicity-based deficiencies persist. Health-care providers and policymakers might specifically target the ED as a place to initiate interventions designed to reduce race-based disparities in health.
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Affiliation(s)
- Edwin D Boudreaux
- Department of Emergency Medicine, Cooper Hospital, One Cooper Plaza, Camden, NJ 08103-1489, USA.
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Abstract
Preschool children's adherence to asthma therapy is often sub-optimal and can result in decreased quality of life for children and parents, as well as an increased risk for dangerous asthma exacerbations. Asthma management for the preschool child presents some unique challenges to adherence to therapy, including the child's limited ability to communicate, multiple caregivers responsible for medications, and parental concerns about medications. Parent beliefs, characteristics of the regimen, and family functioning have been associated with adherence levels. Understanding and improving adherence to asthma therapy for the preschool child will necessarily require addressing these age-specific concerns.
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Affiliation(s)
- C S Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Bonner S, Zimmerman BJ, Evans D, Irigoyen M, Resnick D, Mellins RB. An individualized intervention to improve asthma management among urban Latino and African-American families. J Asthma 2002; 39:167-79. [PMID: 11990232 DOI: 10.1081/jas-120002198] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We hypothesized that an educational intervention based on a readiness model would lead to improved health outcomes among patients with asthma. Within a randomized control design in an urban Latino and African-American community we conducted an intensive three-month pediatric intervention. A Family Coordinator provided patient education based on a readiness-to-learn model, and facilitated improved interactions between the patient and the doctor. Family education addressed the most basic learning needs of patients with asthma by improving their perception of asthma symptom persistence using asthma diaries and peak flown measures. The physician intervention focused cliniciancs' attention on patients' diary records and peak flow measures, and encouraged physicians to use stepped action plans. Patients were also tested for allergic sensitization and provided strategies to reduce contact with allergens and other asthma triggers. The results showed significant improvements by intervention group families on measures of knowledge, health belief, self-efficacy, self-regulatory skill, and adherence; decreases in symptom persistence and activity restriction; and increased prescription of anti-inflammatory medication by the physicians of the intervention group families.
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Affiliation(s)
- Sebastian Bonner
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York 10029, USA.
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39
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Policy Statements Adopted by the Governing Council of the American Public Health Association, October 24, 2001. Am J Public Health 2002. [DOI: 10.2105/ajph.92.3.451] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations.
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Affiliation(s)
- Susan M Swider
- Department of Community and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL 60612, USA.
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41
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Lwebuga-Mukasa J, Dunn-Georgiou E. A school-based asthma intervention program in the Buffalo, New York, schools. THE JOURNAL OF SCHOOL HEALTH 2002; 72:27-32. [PMID: 11871359 DOI: 10.1111/j.1746-1561.2002.tb06508.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This project investigated the feasibility and effectiveness of a school asthma program in reducing asthma exacerbations among school children. In 1997-1998, two schools were selected for a case control pilot study. The intervention required that students with asthma, who needed medication daily at school, must present a written plan from the health care provider. Students with asthma were identified through parent/guardian or school reports. The pilot program was expanded into five schools in 1998-1999. All schools kept records of rescue treatments for asthma episodes. The pilot intervention resulted in an 80% decrease in rescue treatments from 1996-1997 to 1997-1998. In the additional five schools, an overall decrease of 17% occurred in rescue treatments during 1998-2000. Overall, 65% of physicians provided requested Asthma Care Plans (ACP). In two schools, the number of asthma care plans that required anti-inflammatory medications tripled. Preliminary results indicate this school asthma program proved feasible and effective in reducing the frequency of asthma exacerbations at school.
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Affiliation(s)
- Jamson Lwebuga-Mukasa
- Division of Pulmonary and Critical Care, Dept. of Medicine, Kaleida Health Buffalo General Division, SUNY, Buffalo School of Medicine and Biomedical Sciences, 100 High St., Buffalo, NY 14203, USA.
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Abstract
Is it healthy to be wealthy? The answer to this simple but provocative question can be found in a wide variety of published studies, which evaluate the socio-economic equity of healthcare and the socio-economic impact of diseases. Studies have focused on avoidable mortality, race and ethnicity, environment and access to healthcare services, and many found supporting facts of the above thesis, mostly based on cardiovascular diseases. But what about asthma? Additional factors such as risk behaviours e.g. smoking, excessive use of beta-agonists or general non-compliance with asthma medication have been investigated and found to be contributing to adverse health outcomes. Prevalence and incidence of asthma is higher in people with high socio-economic status (SES), but disease severity and premature mortality is more than twice as common in populations with low SES. The key to reduce the large socio-economic impact is, therefore, to improve the management of patients with more severe diseases. Because those patients are found more often in low SES groups, new approaches such as community disease management programmes, probably provided by a multi-disciplinary care team, have to be established. Current financial incentives within the largely sectored healthcare system are counterproductive. Furthermore, a better co-ordination of the goals of public healthcare experts with those providing individual 'clinical' healthcare is needed. Clearly communicated healthcare goals are needed to create common incentives and shared visions. Cornerstones of the new disease management efforts are co-ordinated care, high quality innovative medicines and a well-educated patient. This might help improve the implementation of current asthma management knowledge into practice.
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Affiliation(s)
- T Volmer
- Glaxo Wellcome GmbH & Co, Hamburg, Germany.
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43
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Dolinar RM, Kumar V, Coutu-Wakulczyk G, Rowe BH. Pilot study of a home-based asthma health education program. PATIENT EDUCATION AND COUNSELING 2000; 40:93-102. [PMID: 10705068 DOI: 10.1016/s0738-3991(99)00072-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Caring for a child with asthma can affect the parent's coping and well-being and coping strategies. This study examined the influence of a home-based asthma health education program on parental coping and quality of life. DESIGN Randomized controlled non-blinded clinical trial. SETTING Northern community pediatrician's office. PATIENTS Families whose children, under the age of 11, had chronic stable asthma, and who presented to the pediatrician's office for continuing care; those with an acute exacerbation of asthma were excluded. INTERVENTIONS Families were randomly assigned to receive either a single two-hour, standardized home-based asthma health education session or a booklet representing conventional care. MAIN OUTCOME MEASURES One and three-months following the intervention, assessments were obtained for coping measured by Hymovich's Parent Perception Inventory (PPI), quality of life measured by the Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) and change in asthma measured by the Caregiver Perception of Change (CPC) survey. RESULTS Forty families were recruited and randomized; baseline characteristics were similar between groups. At the final follow-up, reduction in parental need for asthma information (p = 0.04), reduction in parental concerns (p = 0.02) and increased use of coping strategies (p = 0.04) were observed in the home-based care group. Improvement was noted in the parent's perception of their child's asthma in the home-based asthma education group (p = 0.01). Quality of life as measured by the PACQLQ remained unchanged over the intervention period (p > 0.05). CONCLUSIONS These results suggest the use of a one-time, flexible, home-based intervention to assist families caring for children with asthma should be considered and appears effective.
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Affiliation(s)
- R M Dolinar
- Laurentian University, School of Nursing, 935 Ramsey Lake Road, Sudbury ON P3E 2C6, Ontario, Canada.
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Zuvekas A, Nolan L, Tumaylle C, Griffin L. Impact of community health workers on access, use of services, and patient knowledge and behavior. J Ambul Care Manage 1999; 22:33-44. [PMID: 11184887 DOI: 10.1097/00004479-199910000-00007] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community health workers have been used in health centers for several decades. Known by various names (e.g., community health advisors, outreach workers, promotoras), they are trusted community members providing informal community-based health-related services and establishing vital links between health providers and the community. They perform many functions, including outreach and case finding, health education, translation, patient transportation, and case management (under the supervision of a nurse or social worker). This article, based on a study of community health worker programs at seven sites, is intended to share the lessons learned that could be helpful to other program managers and to examine the outcomes of such programs.
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Affiliation(s)
- A Zuvekas
- Center for Health Services Research and Policy, George Washington University Medical Center, Washington, DC, USA
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Petersen DL, Murphy DE, Jaffe DM, Richardson MS, Fisher EB, Shannon W, Sussman L, Strunk RC. A tool to organize instructions at discharge after treatment of asthmatic children in an emergency department. J Asthma 1999; 36:597-603. [PMID: 10524543 DOI: 10.3109/02770909909087297] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Asthma exacerbations continue to be a major cause of visits to emergency departments (ED). Comprehensive care in the outpatient setting, with planning for early intervention for exacerbations, can reduce emergency visits. Thus, a major goal of ED intervention is to establish a link between the patient and the provider of ongoing asthma care, where complete education can be achieved and reinforced over time. When designing the Asthma 1-2-3 Plan discharge teaching tool for the ED, consideration was given to educational format, readability, patient population, and setting in which education was to be delivered. To evaluate use of the plan, ED records of patients enrolled in a separate asthma study, the Neighborhood Asthma Coalition (NAC), were audited for two 8-month intervals, May-December 1993 (before initiation of the plan) and May December 1994 (starting 1 month after completion of pilot testing on the plan in the ED). To evaluate effectiveness of the plan, records of physicians who cared for children in the NAC were evaluated. The database was reviewed for the date of the first visit for planned review of asthma that occurred after the acute asthma ED visit. After introduction of the plan, the proportion of children told to return to the physician for follow-up increased from 54% to 81%. The proportion of children given advice to return to their physician within the recommended 3 days or less increased from 11% to 54%. Chi2 Analyses showed that these changes were both statistically significant (p<0.0001). The plan was not effective in achieving increased follow-up visits for regular asthma care, in that 7% returned for follow-up within 7 days after an ED visit before the plan and only 6% returned for such a visit after the Plan. Successful initiation of a focused discharge teaching tool into the routine of the ED increased appropriate advice given at time of discharge from the ED. Although unsuccessful in increasing appropriate follow-up, the present intervention uses the ED not as a base for asthma education, but as a point for contacting patients in need of regular care and education, and for promoting access to that regular care.
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Affiliation(s)
- D L Petersen
- Department of Respiratory Care, St. Louis Children's Hospital, Missouri 63110, USA.
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46
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Affiliation(s)
- W W Addington
- Rush Primary Care Institute, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
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Persky V, Coover L, Hernandez E, Contreras A, Slezak J, Piorkowski J, Curtis L, Turyk M, Ramakrishnan V, Scheff P. Chicago community-based asthma intervention trial: feasibility of delivering peer education in an inner-city population. Chest 1999; 116:216S-223S. [PMID: 10532497 DOI: 10.1378/chest.116.suppl_2.216s] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The most effective means of educating children with asthma and their families has not been clearly demonstrated in previous studies. Peer education is uniquely suited to the complex problems encountered in underserved populations. The purpose of this study was to show the feasibility of delivering a peer education program for children with asthma and the effect of the program on indoor allergen levels in an inner-city population in Chicago. Overall, the program was well received. Baseline allergen levels were consistent with some previous studies in showing low levels of mite allergens and high levels of cockroach allergens, with 79.6% of samples having levels > 8 U/g. A total of 28.2% of samples had cat allergen levels > 2 microg/g, although only 9.7% of homes had cats, confirming previous reports that cat allergen is ubiquitous. Mold levels were seasonal, with the highest levels in the summer. Results from this study suggest that intervention programs should focus more on elimination of cockroaches than was previously appreciated, while minimizing the use of pesticides, and on identification of the sources of cat allergen. Structural and psychosocial issues in homes need to be addressed in future studies. This study has demonstrated the feasibility of delivering peer education in a inner-city population and highlighted the need for comprehensive intervention strategies addressing complex issues facing underserved neighborhoods.
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Affiliation(s)
- V Persky
- Epidemiology and Biostatistics Division of the School Public Health, University of Illinois at Chicago, 60612, USA
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48
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Abstract
Racial and ethnic minorities of low socioeconomic status residing in urban environments currently referred to as inner cities appear to represent a population that is disproportionately at high risk for asthma morbidity and mortality. Epidemiologic studies suggest that key risk factors contributing to asthma morbidity within the inner city include social demography, the physical environment (indoor and outdoor), and health care access and quality. This epidemiologic literature has helped to define opportunities for successful intervention strategies in these high-risk populations. Studies of the effectiveness of community-based and health system-based interventions with specific focus on inner-city populations are beginning to emerge in the literature.
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Affiliation(s)
- E N Grant
- Department of Immunology and Microbiology, Rush Medical College, Chicago, IL 60612, USA
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49
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Hanson J. Parental self-efficacy and asthma self-management skills. JOURNAL OF THE SOCIETY OF PEDIATRIC NURSES : JSPN 1998; 3:146-54. [PMID: 9884948 DOI: 10.1111/j.1744-6155.1998.tb00222.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether a formal asthma self-management program and social support using lay health advisors increases parent self-efficacy in the management of their child's asthma, and whether parent self-efficacy predicts asthma self-management skills. DESIGN Quasi-experimental with four time points measured over 2 years. PARTICIPANTS Low-income, primarily Hispanic parents (N = 303) of children with moderately severe to severe asthma. SETTING A Southwestern university medical setting in a rural state. MAIN OUTCOME MEASURES Parent self-efficacy and parent asthma self-management skill score scales. RESULTS Parent self-efficacy increased significantly from baseline, but there were no significant differences between the control and treatment groups. The increase in self-efficacy was apparent at 6 months, then leveled off. Parent self-efficacy at either baseline or 12 months did not predict parents' asthma self-management skill score. CONCLUSIONS Individual education was just as effective as group education in increasing parental self-efficacy. Parents felt more comfortable treating asthma episodes than preventing them, thus clinicians need to spend time teaching preventive strategies.
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Affiliation(s)
- J Hanson
- Student Health Center, University of New Mexico, Albuquerque, USA
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50
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Clark NM, Bailey WC, Rand C. Advances in prevention and education in lung disease. Am J Respir Crit Care Med 1998; 157:S155-67. [PMID: 9563775 DOI: 10.1164/ajrccm.157.4.nhlbi-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- N M Clark
- University of Michigan School of Public Health, Ann Arbor 48109-2029, USA
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