Community health worker support improves inhaler adherence in urban children with asthma

September 22, 2022

4 minute read

Source/Disclosures

Disclosures:
Pappalardo reports being a member of the board of directors of the Chicago Asthma Consortium and of the medical advisory boards of Sanofi and Takeda; be a consultant for OptumRx / United Health Group; and receive travel support from the Asthma and Allergy Foundation of America for speaking at the American Asthma Summit in 2019. Please see the study for relevant financial information from all other authors.


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Key points to remember:

  • Community health worker services were associated with improvements in inhaler technique, possession of inhaled corticosteroids, and adherence compared to certified asthma educator services.
  • Improvements in inhaler technique were maintained for 24 months in children who received the services of a community health worker.
  • Systemic and policy changes in health care are needed to improve outcomes related to environmental exposures that trigger asthma.

According to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

However, changes in health care policy are needed to support lasting improved outcomes for these children, the researchers wrote.

girl using asthma inhaler
Source: Adobe Stock

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

Andrea A. Pappalardo

“Many factors contribute to asthma-related health disparities and make low-income urban children less likely to receive guideline-based asthma care,” she said. for follow-up. “We know that self-management support can help, but it was unclear how to implement self-management support in real settings.”

Study design and methods

The Asthma Action at Erie Trial recruited 223 children ages 5 to 16 (mean age, 9.4 years; standard deviation, 3) with uncontrolled asthma who were attending a federally licensed health center in the Chicago area. Additionally, 85.2% of these patients were Hispanic and 44% were female.

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

Data collection was repeated in each patient’s home at 6, 12 and 24 months and by telephone at 18 months. Monthly phone calls collected updates on hospitalizations, emergency and urgent care visits, and oral corticosteroid surges.

The researchers also hired and trained a certified asthma educator (AE-C) and two community health workers (CHWs) who were all bilingual in English and Spanish.

“The practical value of ASCs and AE-Cs is known to those who have worked in the community asthma and allergy field for years,” Pappalardo said.

Within one month of enrollment and again at 6 months, all 108 children in the AE-C arm were offered a one-hour health center session that covered asthma symptoms, control, medications , compliance, technique, triggers, action plans and any caregiver or child concerns, with telephone follow-up 2 weeks after each session.

The 115 children in the ASC arm were offered 10 visits mainly at home over 12 months. These visits focused on the same asthma topics, the researchers said, but were flexible to cover specific needs and include behavior change plans, in addition to identifying triggers at home and discussing the way to change them.

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

A previous analysis of the trial results indicated that the CHW and AE-C groups achieved similar results in asthma control, which Pappalardo said was surprising because the CHWs had significantly more contact with families. . The current analysis examined the impacts of the intervention on adherence, inhaler technique, and home trigger reduction.

Study results

At 6 months, the ASC group had a 9.8% (95% CI, 4.2% to 15.32%) improvement in inhaler technique that was maintained after the end of the intervention. But the technique of medication in AE-C got worse (P = 0.013), resulting in a difference of 13.4% (95% CI, 7.8% to 18.9%) between the groups at 12 months. At 24 months, the difference was 10% (95% CI, 4.7%-15.3%), which the researchers said was significant.

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

In an adjusted model, the CHS group improved adherence to ICS at 12 months, but not the AE-C group, with a difference of 16% (95% CI, 2.3% to 29.7%) between groups, although both arms are again similar at 24 months.

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

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

With the exception of improvements in strong odor exposures 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 triggers that they can control, researchers noted that many triggers are related to housing, infrastructure, and other factors beyond their control, requiring public health changes at a systemic level. and politics.

Yet the researchers stated that CHW interventions linked directly to a medical system can improve attendance and adherence to ICS treatment among children with asthma who live in urban settings. However, replicating these results can be difficult.

“Many states don’t have formal certification for CHWs, which makes standardization difficult,” Pappalardo said. “Clinical groups should follow best practices for training and hiring CHWs, as outlined by the CHW Core Consensus Project.”

Reference:

For more information:

Andrea A. Pappalardo, MD, FAAAAI, FACAAI, can be contacted at appappa2@uic.edu.

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