Nurse Case Management and Housing Interventions Reduce Allergen Exposures: The Milwaukee Randomized Controlled Trial

Abstract

Objective. We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children.Methods. Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n564) or an intervention (n557) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present.Results. For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft 2 ]) to postintervention (11 mg/ft 2 ) (p,0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly.Conclusion. The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust.

Environmental Remediation in the Treatment of Allergy and Asthma: Latest Updates

“…More recently, Breysse et al [74] conducted a randomized control trial in Milwaukee to examine the impact of environmental remediation and nursing case management in the homes of asthmatics. The intervention included minor repairs of the home, thorough cleaning, and IPM.…”

“…The intervention included minor repairs of the home, thorough cleaning, and IPM. After the intervention, the control group had 72 % more total settled dust [74]. Although there was a decrease in settled dust in the intervention group, there was no significant difference in the concentration of allergens between the two groups [74].…”

Dental case manager encounters: the association with retention in dental care and treatment plan completion

“…Although the link between oral and overall health has been well established, medical case managers may not have the resources available to address the dental health needs of their clients. Medical case managers work to keep patients engaged in medical care as well as eliminating barriers that patients may encounter in accessing care . These barriers can include lack of housing or food insufficiency, the need for mental health treatment, including drug and alcohol counseling.…”

“…Even less is known about the impact of dental case managers on patient outcomes such as retention in oral health care or changes in oral health‐related quality of life. In contrast to the limited literature available regarding dental case managers, the role of medical case managers in ensuring that people receive needed medical services is well documented . Several studies have examined the impact of HIV medical case managers in connecting patients to and assisting them to remain in care .…”

Effectiveness of mite‐impermeable covers: a hypothesis‐generating meta‐analysis

“…All of the new trials did not include full-cover technology and were excluded [30][31][32][33][34][35]. Data were extracted from 12 trials [15,16,19,28,29,[36][37][38][39][40][41][42].…”