Effect of a Self-management Support Intervention on Asthma Outcomes in Older Adults

Abstract

IMPORTANCE Older adults with asthma have worse control and outcomes than younger adults. Interventions to address suboptimal self-management among older adults with asthma are typically not tailored to the specific needs of the patient. OBJECTIVE To test the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes. DESIGN, SETTING, AND PARTICIPANTS Three-arm randomized clinical trial conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City. Adults 60 years and older with persistent, uncontrolled asthma were identified from electronic medical records at an academic medical center and a federally qualified health center. Of 1349 patients assessed for eligibility, 406 met eligibility criteria, consented to participate, and were randomized to 1 of 3 groups: home-based intervention, clinic-based intervention, or control (usual care). A total of 391 patients received the allocated treatment INTERVENTIONS Screening for psychosocial, physical, cognitive, and environmental barriers to asthma control and self-management with actions to address identified barriers. The intervention was delivered in the home or primary care practices by asthma care coaches. MAIN OUTCOMES AND MEASURES Primary outcomes were the Asthma Control Test, Mini Asthma Quality of Life Questionnaire, Medication Adherence Rating Scale, metered dose inhaler technique, and emergency department visits for asthma care. Primary analyses compared intervention (home or clinic based) with usual care. RESULTS Of the 391 patients who received treatment, 58 (15.1%) were men, and the mean (SD) age was 67.8 (7.4) years. After accounting for baseline scores, scores on the asthma control test were better in the intervention groups vs the control group (difference-indifferences at 3 months, 1.

Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases

“…The common barriers to medication adherence for CVD include unaffordable costs, lack of belief in the necessity of medication, side effects of medication or medication concerns, complex regimens, forgetfulness, lack of family or social support, depression, lack of disease knowledge, and inconvenient access to medications or care ( Choudhry et al, 2011 ; Nair et al, 2011 ; Müller et al, 2015 ; Zullig et al, 2015 ; Banerjee et al, 2016 ; Crawshaw et al, 2016 ; Xavier et al, 2016 ; Wang et al, 2019 ). There are some uncommon barriers that are reported relatively less often such as asymptomatic diseases ( Devine et al, 2018 ), a poor provider–patient relationship, lack of understanding of the benefits of medication, prioritization issues or a busy lifestyle, disruptions to daily routines, and stigma or social embarrassment ( Quach et al, 2009 ; Gellad et al, 2011 ; Nair et al, 2011 ; Farsaei et al, 2014 ; Müller et al, 2015 ; Newman-Casey et al, 2015 ; Zullig et al, 2015 ; Campbell et al, 2016 ; Sweileh, 2018 ; Venditti et al, 2018 ; Federman et al, 2019 ; Sweileh et al, 2019 ). For CVD, there are several diseases or conditions that may be symptomless such as hypertension, hypercholesterolemia, and even coronary heart diseases in some cases.…”

A behavioral intervention can decrease asthma exacerbations in older adults

“…Of note, other trials in older adults that have found that decreased exacerbation rates do not always show meaningful changes in lung function parameters. 13,14 The intervention was specifically designed to have individual components as well as group interaction. Group sessions have been found to be effective for older adults in a number of interventions and conditions, such as diabetes and osteoarthritis.…”

Eficacia y seguridad de la inmunoterapia subcutánea para alérgenos inhalables en pacientes con alergia respiratoria a un año de tratamiento

“…Trained lay health workers (also known as community health workers) can deliver discrete areas of respiratory care such as asthma self-management education. In one study, this was associated with increased symptom-free days and reduced healthcare utilization compared with usual care, 397 in another study, with improved adherence, inhaler technique, symptom control and quality of life and reduced emergency department visits compared with usual care, 371 and in a third study, comparable outcomes to those achieved by practice nurses based in primary care 398 (Evidence B). These findings suggest the need for additional studies to assess applicability in other settings and populations.…”

“…Pharmacists, nurses and trained lay health workers can provide highly effective inhaler skills training. 362,[369][370][371] Some inhaler devices and techniques for their use are illustrated on the GINA website (www.ginasthma.org) and the ADMIT website (www.inhalers4u.org). • If different options are available, encourage the patient to participate in the choice…”