Use of home visits in pediatric severe asthma: randomized controlled trial*

Abstract

Objective: To evaluate the effectiveness of home visits in a group of children and adolescents with severe asthma by using the inhalation technique score and adherence rates to drug treatment. Method: A 12-month randomized controlled trial involving patients aged between three and 17 years under regular follow-up treatment at a pediatric pulmonology outpatient clinic of a university hospital in southeastern Brazil. A group of patients received only outpatient consultations and the other group received home visits from nurses in addition to outpatient consultations. The differences between groups were analyzed through the outcomes of inhalation technique scores and treatment adherence rate. Results: Participation of 29 patients. In the intervention group, there was a statistically significant increase in inhalation technique scores (p<0.05) and elimination of critical errors between the first and the second evaluation, and results were maintained in the third evaluation. In the control group, there were no significant changes in inhalation technique scores. Rates of adherence to drug treatment in both groups did not rise. Conclusion: Home visits were effective for improving inhalation technique scores in patients with severe asthma. Brazilian Registry of Clinical Trials: RBR-8GZWZP.

Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review

“…Only two effective intervention studies were classified as low reliability and categorized as Level 3 25,34 . The ineffective and low‐reliability intervention studies were either classed as Level 1 (no tailoring), 23,27,33 Level 2 perceptual only, 37,39 or both but not tailored, 20 or Level 3 18,31,36,41 . Therefore, only six interventions using Level 3 PAPA were ineffective ( n = 6/25, 24%), four of which were classed as low‐reliability intervention studies.…”

“…Main reasons for exclusion were as follows: study design not an RCT, no usual care control group, medication adherence not included as a usable outcome, and trial compared medications or was conducted in adults. Twenty‐five studies were included in the narrative synthesis 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ; see full PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) diagram (Figure 1 ).…”

“…Nearly one‐third of the studies were considered low risk ( n = 8/25), 17 , 21 , 22 , 29 , 30 , 32 , 33 , 38 with most ( n = 11/25) being considered moderate risk. 18 , 19 , 20 , 24 , 26 , 28 , 31 , 34 , 35 , 39 , 40 Six studies were considered high risk 23 , 25 , 27 , 36 , 37 , 41 ( n = 6/25) (Table 3 and Figure 2 ).…”

“…53,54 The most common BCTs used in effective interventions were prompts/cues (e.g., reminders); feedback and monitoring; pharmacological support and instruction of how to perform a behavior. Each BCT was found to be most effective as part of complex 33 Baren et al 17 Chatkin et al 21,a Teach et al 38,a Chan et al 22,a Julious et al 29,a Kenyon et al 30 Koumpagioti et al 32,a Moderate risk Canino et al 20 Gustafson et al 26 Morton et al 35,a van Es et al 39 Jan et al 28 Vasbinder et al 40,a Bresolini et al 18 Garrett et al 24,a Kosse et al 31 Burgess et al 19,a Lv et al 34,a High risk Stergachis et al 37 Hederos et al 27 Guendelman et al 25,a Mosnaim et al 36 Wiecha et al 41 Davis et al 23 a Significant effect reported for increasing adherence in the intervention group compared with the control.…”

Interventions to improve adherence in children with asthma: A systematic review

“…The eight effective studies were conducted in Brazil 24 ; Greece 41 ;New Zealand 23; 32 ; China 44 ; the USA 38 ; the UK 34; 36 ; and the Netherlands 37 . The ineffective studies were conducted in the USA 21; 26; 28; 31; 39; 42 , Taiwan 35 , Brazil 45 , the Netherlands 40 and Sweden 43; 46 . Effective studies took place in an emergency care setting 23; 38 ; primary care 24; 34 ; hospital outpatients 33; 36; 37; 41; 44 ; and in the community 32; 44 .…”