Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: A randomized controlled trial - 28/08/11
Abstract |
Background |
Improving inhaled corticosteroid (ICS) adherence should improve asthma outcomes.
Objective |
In a randomized controlled trial we tested whether an individualized problem-solving (PS) intervention improves ICS adherence and asthma outcomes.
Methods |
Adults with moderate or severe asthma from clinics serving urban neighborhoods were randomized to PS (ie, defining specific barriers to adherence, proposing/weighing solutions, trying the best, assessing, and revising) or standard asthma education (AE) for 3 months and then observed for 3 months. Adherence was monitored electronically. Outcomes included the following: asthma control, FEV1, asthma-related quality of life, emergency department (ED) visits, and hospitalizations. In an intention-to-treat-analysis longitudinal models using random effects and regression were used.
Results |
Three hundred thirty-three adults were randomized: 49 ± 14 years of age, 72% female, 68% African American, 7% Latino, mean FEV1 of 66% ± 19%, and 103 (31%) with hospitalizations and 172 (52%) with ED visits for asthma in the prior year. There was no difference between groups in overall change in any outcome (P > .20). Mean adherence (61% ± 27%) decreased significantly (P = .0004) over time by 14% and 10% in the AE and PS groups, respectively. Asthma control improved overall by 15% (P = .002). In both groups FEV1 and quality of life improved by 6% (P = .01) and 18% (P < .0001), respectively. However, the improvement in FEV1 only occurred during monitoring but not subsequently after randomization. Rates of ED visits and hospitalizations did not significantly decrease over the study period.
Conclusion |
PS was not better than AE in improving adherence or asthma outcomes. However, monitoring ICS use with provision of medications and attention, which was imposed on both groups, was associated with improvement in FEV1 and asthma control.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, adherence, adults, inner-city asthma, problem solving, health disparities, inhaled corticosteroids
Abbreviations used : AE, AQOL, CES-D, DAL, ED, FVC, ICS, ITT, PS
Plan
Supported by National Institutes of Health grants HL070392 and HL088469. A.J.A. was supported by HL070392, HL088469, and HL099612. X.W., D.K.B., T.T.H., R.G., C.P., B.A., and S.G. were supported by HL070392 and HL099612. D.P. was supported by HL070392. |
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Disclosure of potential conflict of interest: A. J. Apter receives research support from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) and Astra Zeneca/Bristol-Myers Squibb. D. K. Bogen receives research support from the NIH/NHLBI. C. S. Rand is on the advisory board for the Merck Foundation/MCAN and has consultant arrangements with TEVA. D. Polsky has consultant arrangements with GlaxoSmithKline. The rest of the authors have declared that they have no conflict of interest. |
Vol 128 - N° 3
P. 516 - septembre 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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