CHW support improves adherence to inhalers in urban children with asthma

September 22 2022

4 minutes to read

Disclosures:
Pappalardo reported being on the Board of Directors of the Chicago Asthma Federation and the Medical Advisory Boards of Sanofi and Takeda; Being a consultant for OptumRx / United Health Group; and received travel support from the Asthma and Allergy Foundation of America for her participation in speaking at the American Asthma Summit in 2019. Please see the study for all relevant financial disclosures by other authors.


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The main takeaway:

  • CHW services were associated with improvements in inhaler technique, possession of inhaled corticosteroids and adherence when compared with approved asthma counselor services.
  • Improvements in inhalation technique persisted at 24 months among children who received CHW services.
  • Methodological and policy changes in health care are necessary to improve outcomes for environmental exposures that lead to asthma.

Visits by a community health worker were associated with improved adherence to medication and inhaler technique among urban children with asthma, according to a study published in Journal of Allergy and Clinical Immunology: in practice.

However, the researchers wrote that changes in health care policy are necessary to support sustainable improved outcomes for these children.

Source: Adobe Stock

“This study was designed to try to reduce the health disparities for asthma,” Andrea A. Pappalardo, MD, FAAAAI, FACAAI, An assistant professor of medicine and pediatrics at the University of Illinois at Chicago, told Healio.

Andrea A. papalardo

“Many factors contribute to asthma health disparities and result in lower likelihood of low-income children in urban areas receiving guidance-based asthma care,” she continued. “We know that self-management support can help, but how to implement self-management support in real-world settings has not been clear.”

Study design and methods

The Airy Trail Asthma Action recruited 223 children aged 5 to 16 years (mean age, 9.4 years; standard deviation, 3) With uncontrolled asthma who are enrolled in a federally qualified health center in the Chicago area. Also, 85.2% of those The patients were of Hispanic origin and 44% of girls.

During the baseline assessment, researchers collected information about each child’s demographics, asthma symptoms and history, medications, inhaler technique, triggers, psychosocial factors and other data.

Data collection was repeated at each patient’s home at 6, 12 and 24 months and by telephone at 18 months of age. Monthly phone calls collected updates about hospital admissions, ED treatment and urgent care visits and oral corticosteroid infusions as well.

The researchers also recruited and trained a certified asthma trainer (AE-C) and two community health workers (CHWs) who all speak both English and Spanish.

The practical value of both CHWs and AE-C is known to those who have worked in community asthma And space for allergies for years,” Pappalardo said.

Within a month of enrollment and again at 6 months, 108 children in arm AE-C were offered a one-hour session in the health center that covered asthma symptoms, control, medication, adherence, technique, triggers, action plans, anything related to the caregiver or the child, with follow-up over the phone Two weeks after each session.

The 115 children in the CHW arm were offered 10 mostly at-home visits over a 12-month period. The visits focused on the same topics as asthma, but were flexible to cover specific needs and include behavior change plans, as well as identifying factors in the home and discussing how to change them, the researchers said.

Families in the CHW group had a mean of seven visits (interquartile range, 4), while 49% of the AE-C group received no interventions, 29% had one session and 22% had two sessions. Costs included $74 per CHW visit and $135 per AE-C session.

Previous analysis of trial results indicated that the CHW and AE-C groups achieved similar results in controlling asthma, which Pappalardo described as surprising because CHWs had significantly more contact with families. The current analysis examined the effects of the intervention on adherence, inhalation technique and trigger reduction in the home.

Results

At 6 months, the CHW group had a 9.8% (95% CI, 4.2%-15.32%) improvement in the inhalation technique that persisted after the end of the intervention. But the treatment approach for AE-C got worse (s = .013), resulting in a difference of 13.4% (95% CI, 7.8%-18.9%) between groups at 12 months. At 24 months, the difference was 10% (95% CI, 4.7%-15.3%), which the researchers described as significant.

Whereas 44.4% of children had an inhaled corticosteroid (ICS) at home at baseline, 56% of the CHW group and 35% of the AE-C group had an ICS at home at 12 months (OR = 2.39; 95% CI, 0.99 -5.79), although this effect did not persist at 24 months (OR = 1.52; 95% CI, 0.59–3.92).

In a modified model, the CHS group improved ICS adherence at 12 months but the AE-C group did not, with a difference of 16% (95% CI, 2.3%-29.7%) between the two groups, although both arms were once similar. Others at 24 months old.

“This secondary analysis showed, as we expected, that CHW intervention was associated with better adherence to asthma treatments and better inhaler technique,” Pappalardo said.

“When we discontinued the intervention, behaviors deteriorated, indicating that continued CHW services are necessary to maintain adherence to medication and correct inhaler technique,” she continued.

Excluding improvements in exposure to strong odors in both the CHW group (OR = 0.25; 95% CI, 0.13-0.47) and the AE-C group (OR = 0.38; 95% CI, 0.19-0.78) at 24 months, the researchers continued , There were no significant changes in trigger exposures in either group.

Although families change the factors they can control, researchers note that many motivators are related to housing, infrastructure, and other factors beyond their control, requiring changes in public health at a systemic and political level.

However, the researchers said that CHW interventions directly linked to the medical system could improve presence and adherence to ICS treatment among asthmatic children living in urban areas. Replicating these results can be difficult.

“Many countries do not have formal certification of community health workers, which makes the standard-setting process difficult,” Pappalardo said. “Clinical groups should follow best practices for training and hiring CHWs, as outlined in the CHW Core Consensus Project.”

Reference:

for more information:

Andrea A. Pappalardo, MD, FAAAAI, FACAAIAnd the She can be reached at appappa2@uic.edu.