Long-term Effectiveness of a Peer-Led Asthma Self-management Program on Asthma Outcomes in Adolescents Living in Urban Areas

Rhee, Hyekyun; Love, Tanzy; Wicks, Mona; Tumiel-Berhalter, Laurene; Sloand, Elizabeth; Harrington, Donald; Walters, Leanne

doi:10.1001/jamanetworkopen.2021.37492

Cited by 10 publications

(2 citation statements)

References 53 publications

(88 reference statements)

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“…Providing culturally-specific education is important and effective [39]. In a randomized-controlled, multicenter study for adolescents with asthma comparing asthma education delivered by a peer-leader versus an adult, Rhee et al [40 ▪ ] found significantly improved asthma control, quality of life, and self-efficacy in the peer-leader group. Both groups showed improvement in asthma outcomes, reinforcing the value of community-based asthma education.…”

Section: Social Disparity and Care Deliverymentioning

confidence: 99%

Socioeconomic determinants of asthma health

Simoneau

Gaffin

2023

Current Opinion in Pediatrics

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Purpose of reviewThe current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism.Recent findingsMany social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community – via telehealth, school-based health centers, or peer mentors – are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist ‘redlining’ policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes.SummaryRoutine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.

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Section: Social Disparity and Care Deliverymentioning

confidence: 99%

Socioeconomic determinants of asthma health

Simoneau

Gaffin

2023

Current Opinion in Pediatrics

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“…These documented disparities may persist due to the lack of a comprehensive approach for asthma care that is scalable, sustainable, and widely disseminated [ 22 ]. Previous programs, such as asthma action plans [ 43 ], allergen remediation [ 36 , 37 , 44 – 46 ], education [ 24 , 47 – 49 ], peer support [ 50 ], case management [ 51 – 53 ], or community health workers [ 54 – 57 ], have shown positive results on a local level or in the short-term; however, no single program demonstrated widespread and sustainable outcomes improvement.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design

Ludden

O’Hare

Shade

et al. 2022

BMC Med Inform Decis Mak

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Background Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. One promising approach to addressing disparities is shared decision making (SDM), a method by which the patient and provider cooperatively make a decision about asthma care. SDM is associated with improved outcomes for patients; however, time constraints and staff availability are noted implementation barriers. Use of health information technology (IT) solutions may facilitate the utilization of SDM. Coach McLungsSM is a collaborative web-based application that involves pediatric patients, their caregivers, and providers in a personalized experience while gathering patient-reported data. Background logic provides decision support so both audiences can develop a well-informed treatment plan together. The goal of this study is to evaluate the implementation of the Coach McLungsSM intervention into primary care. Methods Implementation will be evaluated using a stepped wedge randomized control study design at 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. We will use a generalized linear mixed models with logit link to test the hypothesis for the reduction in exacerbation rates specifying the fixed effects of intervention and time and random effects for practice and practice*time. This design achieves 84% power to detect the hypothesized effect size difference of 10% in overall exacerbation between control (40%) and intervention (30%) periods (two-sided, p = 0.05). Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance). Discussion We anticipate that a tailored implementation of Coach McLungsSM across diverse primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control condition. Trial Registration: Clincaltrials.gov, NCT05059210. Registered 28 September 2021, https://www.clinicaltrials.gov/ct2/show/NCT05059210

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