Interventions to Improve Outcomes for Minority Adults with Asthma: A Systematic Review

Abstract

OBJECTIVES:To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma. DATA SOURCES: Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations. Inclusion criteria: adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS:Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes. RESULTS: Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n=14), followed by Latino/a (n=4), Asian Americans (n=1), or a combination of the above (n=5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results. LIMITATIONS: Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. Systemredesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

“…[2][3][4][5][6] While many valuable ideas to address racial and ethnic health disparities are being pursued outside of the healthcare system, Finding Answers focuses specifically on what can be accomplished once regular access to healthcare services is achieved. Thus, the reviews focused on interventions that occur in or have a sustained linkage to a healthcare delivery setting; programs that were strictly communitybased were outside the scope of the project.…”

“…The asthma paper found that educational interventions were most common, with culturally tailored, skills-based education showing promise. 5 Outpatient support, as well as education for inpatient and emergency department patients, were effective. Similarly, the HIV review noted that interactive, skills-based instruction was more likely to be effective than didactic educational approaches for changing sexual health behavior.…”

“…Over the past seven years, Finding Answers has funded 33 research projects and performed 12 systematic literature reviews, including the five papers in this symposium. [2][3][4][5][6] We are now beginning to leverage this research base to provide technical assistance to organizations that are implementing disparities reduction interventions, such as those participating in RWJF's Aligning Forces for Quality program. 7 This paper summarizes the major lessons learned from the systematic reviews and provides a disparities reduction framework.…”

Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS)

“…Of the few culturally specific interventions for asthma tested in randomised trials,[9–18] only one (a negative study set in the UK) has targeted south Asians. [15] Most have been set in the USA and directed at African American or Hispanic populations, with inconsistent improvements in quality of life[12, 17, 19] and health care use.…”

Exploring Patient Engagement: A Qualitative Analysis of Low-Income Urban Participants in Asthma Research

“…Asthma is a chronic, costly, and often debilitating medical condition that affects more than 25 million people in the US 1 and results in significant healthcare utilization: over 10 million outpatient appointments 2 , 1.5 million emergency department visits, and 400,000 hospitalizations 3 , costing over $30 billion 4 annually. It is well-described that worse health outcomes are seen in low-income and minority patients.…”