Home visits are needed to address asthma health disparities in adults

Abstract

Research on asthma frequently recruits patients from clinics because the ready pool of patients leads to easy access to patients in office waiting areas, emergency departments, or hospital wards. Patients with other chronic conditions, and with mobility problems, face exposures at home that are not easily identified at the clinic. In this article, we describe the perspective of the community health workers and the challenges they encountered when making home visits while implementing a research intervention in a cohort of low-income, minority patients. From their observations, poor housing, often the result of poverty and lack of social resources, is the real elephant in the chronic asthma room. To achieve a goal of reduced asthma morbidity and mortality will require a first-hand understanding of the real-world social and economic barriers to optimal asthma management and the solutions to those barriers.

Predicting admissions for adult asthma exacerbations in North Texas

“…Negative coefficients for median family income and percent of older housing indicate that residents in lower income or older census blocks experience greater numbers of asthma admissions than other people holding other variables constant. This is consistent with recent studies in the U.S. and abroad that continue to highlight problems with asthma management among socioeconomically stressed patients (Bryant‐Stephens et al, ; Neffen et al, ). Coefficients for average speed on road segments and road density suggest that greater levels of traffic in the census block group predict greater use of hospital and ED services for asthma exacerbations holding other variables constant.…”

“…Coefficients for average speed on road segments and road density suggest that greater levels of traffic in the census block group predict greater use of hospital and ED services for asthma exacerbations holding other variables constant. The profile of census blocks contributing higher numbers of admissions for asthma exacerbations that emerges is familiar from evidence gathered in diverse locations across the nation: older, possibly deteriorating, neighborhoods of diverse, or minority residents from lower socioeconomic groups (Bryant‐Stephens et al, ).…”

Regional Disparity in Asthma Prevalence and Distribution of Asthma Education Programs in Texas

“…Lack of knowledge of these barriers does not help health providers to create tailored, personal, and empathetic approaches to asthma management. Depending on their economic situation, adults with asthma might have high morbidity, many hospitalizations and emergency department visits, other comorbidities, and significant barriers including difficulty with transportation to regular outpatient visits [34]. To adequately manage asthma, those suffering from it require an understanding of the nature of asthma, their asthma triggers and how to decrease and prevent them, the basic principles of the treatment protocol, and how to evaluate its control and the characteristics related to their case.…”

Home visits for uncontrolled asthma among low-income adults with patient portal access

“…Third, we found during HVs that patients experienced many exposures that not only might interfere with their ability to communicate with their clinical team but also might undermine their ability to adhere to disease management. 46 CHWs found some participants living as tenants in poorly maintained structures, sometimes having poor ventilation, water leaks, and structural inadequacies. Many homes had strong odors of tobacco smoke.…”