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01-12-2009 | Respiratory | Article

Home visits improve childhood asthma control

Abstract

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MedWire News: Home visits by an asthma specialist can help improve medication adherence, reduce symptom frequency and cut emergency department visits among inner-city children with the respiratory condition, US research shows.

An estimated 6.5 million children in the USA have asthma, which disproportionately affects children from ethnic minorities, explain Kristin Riekert (Johns Hopkins School of Medicine, Baltimore, Maryland) and team in the journal Pediatrics.

To investigate whether home visits by an asthma specialist can improve outcomes among children with the disease, the researchers enrolled 250 children who had visited the emergency room of an inner-city hospital suffering from an asthma attack. The children were aged an average of 7 years and 98% were African American.

The participants were divided into three groups to receive usual care (a booklet with basic asthma information), educational home visits by asthma educators, or educational home visits plus adherence monitoring with feedback and coaching on how to improve adherence.

Follow-up at 6, 12, and 18 months revealed that children in both groups that received home visits had 15% fewer emergency department visits during the study period than those assigned to usual care. Children in the two home visit groups also refilled their inhaled corticosteroid prescriptions significantly sooner than those in the usual care group.

The researchers also found that children who received usual care used oral corticosteroids – a marker of asthma exacerbations – 17% more often than those in either of the other two groups.

There were no significant differences in any of these outcomes between children in the two home-visit groups, the researchers note.

Also there were no significant differences in hospitalization rates among the three groups.

Riekert and team summarize: “Asthma education led to improved adherence and decreased morbidity compared with usual care.

“Adherence feedback did not improve outcomes over education alone.”

They conclude: “Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Mark Cowen

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