Community-based interventions for childhood asthma using comprehensive approaches: a systematic review and meta-analysis

Abstract

Objective We conducted a systematic review and meta-analysis to determine the effectiveness of comprehensive community-based interventions with ≥ 2 components in improving asthma outcomes in children. Methods A systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), Cochrane Library and hand search of reference collections were conducted to identify any research articles published in English between 2000 and 2019. All studies reporting community-based asthma interventions with ≥ 2 components (e.g., asthma self-management education, home environmental assessment or care coordination etc.) for children aged ≤ 18 years were included. Meta-analyses were performed using random-effects model to estimate pooled odds ratio (OR) with 95% confidence intervals (CIs). Results Of the 2352 studies identified, 21 studies were included in the final analysis: 19 pre-post interventions, one randomised controlled trial (RCT) and one retrospective study. Comprehensive asthma programs with multicomponent interventions were associated with significant reduction in asthma-related Emergency Department (ED) visits (OR = 0.26; 95% CI 0.20–0.35), hospitalizations (OR = 0.24; 95% CI 0.15–0.38), number of days (mean difference = − 2.58; 95% CI − 3.00 to − 2.17) and nights with asthma symptoms (mean difference = − 2.14; 95% CI − 2.94 to − 1.34), use of short-acting asthma medications/bronchodilators (BD) (OR = 0.28; 95% CI 0.16–0.51), and increase use of asthma action plan (AAP) (OR = 8.87; 95% CI 3.85–20.45). Conclusion Community-based asthma care using more comprehensive approaches may improve childhood asthma management and reduce asthma related health care utilization.

The impact of childhood asthma on academic performance: A matched population‐based cohort study

“…[5] A comprehensive multimodal asthma management pathway that includes active care co-ordination between acute and primary care settings and community based services, asthma self-management education and active home-based follow-up visits to assess home environmental triggers can reduce asthma hospital presentations by 80%. [42] More intensive asthma management, such as through intensive clinical or case management services, [43] and better asthma symptom control [7] instigated by health professionals, such as through medication to manage symptoms [13] and the development of an asthma management plan, [13,20] could enhance academic performance for young people [7] via reducing the impact of comorbidities on educational outcomes. Raising caregiver awareness of the benefits of adherence to treatment and asthma management strategies [20,44] and further consideration of schoolbased interventions to that could raise awareness with teaching staff and students of the importance of adherence to medication management of asthma (eg inhaler) [1,5,7,20] could also assist in improving performance at school.…”

Models of lifelong care for children and adolescents with chronic conditions in low-income and middle-income countries: a scoping review

“…The management of chronic conditions for children and adolescents requires access to a range of health services since health outcomes are closely linked to behaviour, social and physical environment and socioeconomic status 47 48. Chronic disease management may require the support of a broad and diverse team of providers including physicians, nurses, behavioural specialists, dieticians, psychologists and social workers 49 50. Further, a case manager or care coordinator role on a patient’s care team can serve to adequately incorporate and synchronise long-term clinical and social services.…”

Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma

“…This is in line with our recent meta-analysis of 21 community-based studies on multicomponent interventions, where ED visits and hospitalizations were reduced by up to 75% in children with asthma. 41 Most of these community-based interventions involved reaching out to patients and families in their homes by trained community health workers or nurses for provision of asthma self-management education and assessment of potential asthma triggers within the home environment. 9 , 42 Some of them also facilitated the communication between hospitals and primary care providers, 9 schools or other social services, which is lacking in the current system in New South Wales.…”