TY - JOUR
T1 - Effect of a Self-management Support Intervention on Asthma Outcomes in Older Adults
T2 - The SAMBA Study Randomized Clinical Trial
AU - Federman, Alex D.
AU - O'Conor, Rachel
AU - Mindlis, Irina
AU - Hoy-Rosas, Jamillah
AU - Hauser, Diane
AU - Lurio, Joseph
AU - Shroff, Nandini
AU - Lopez, Ray
AU - Erblich, Joel
AU - Wolf, Michael S.
AU - Wisnivesky, Juan P.
N1 - Funding Information:
This study is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI has established a two-staged approach to its study development, implementation, and analysis of findings. ‚ In Stage I, we will include development of interventions, solidifying partnerships, IRB approval, and training of project staff. Research activities in this Stage I will include: conducting focus groups and one-on-one cognitive interviews with stakeholders to provide feedback on the intervention materials and on the content and flow of the EMR-based asthma decision support tool.
Funding Information:
reported grants from the Patient-Centered Outcomes Research Institute during the conduct of the study. Dr Wolf reported grants from Eli Lilly outside of the submitted work. Dr Wisnivesky reported personal fees from Sanofi, Quintiles, and Banook, as well as grants from Sanofi and Quorum outside of the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: Funding was provided by the Patient-Centered Outcomes Research Institute (grant No. AS-1307-05584).
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - Importance: Older adults with asthma have worse control and outcomes than younger adults. Interventions to address suboptimal self-management among older adults with asthma are typically not tailored to the specific needs of the patient. Objective: To test the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes. Design, Setting, and Participants: Three-arm randomized clinical trial conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City. Adults 60 years and older with persistent, uncontrolled asthma were identified from electronic medical records at an academic medical center and a federally qualified health center. Of 1349 patients assessed for eligibility, 406 met eligibility criteria, consented to participate, and were randomized to 1 of 3 groups: home-based intervention, clinic-based intervention, or control (usual care). A total of 391 patients received the allocated treatment Interventions: Screening for psychosocial, physical, cognitive, and environmental barriers to asthma control and self-management with actions to address identified barriers. The intervention was delivered in the home or primary care practices by asthma care coaches. Main Outcomes and Measures: Primary outcomes were the Asthma Control Test, Mini Asthma Quality of Life Questionnaire, Medication Adherence Rating Scale, metered dose inhaler technique, and emergency department visits for asthma care. Primary analyses compared intervention (home or clinic based) with usual care. Results: Of the 391 patients who received treatment, 58 (15.1%) were men, and the mean (SD) age was 67.8 (7.4) years. After accounting for baseline scores, scores on the asthma control test were better in the intervention groups vs the control group (difference-in-differences at 3 months, 1.2; 95% CI, 0.2-2.2; P =.02; 6 months, 1.0; 95% CI, 0.0-2.1; P =.049; 12 months, 0.6; 95% CI, -0.5 to 1.8; P =.28; and overall, χ2 = 13.4, with 4 degrees of freedom; P =.01). Emergency department visits were lower at 12 months for the intervention groups vs the control group (16 [6.2%] vs 17 [12.7%]; P =.03; adjusted odds ratio, 0.8; 95% CI, 0.6-0.99; P =.03). Statistically significant improvements were observed for the intervention vs control patients in quality of life (overall effect: χ2 = 10.5, with 4 degrees of freedom; P =.01), medication adherence (overall effect: χ2 = 9.5, with 4 degrees of freedom; P =.049), and inhaler technique (metered-dose inhaler technique, correctly completed steps at 12 months, median [range]: 75% [0%-100%] vs 58% [0%-100%]). No significant differences in outcomes were observed between patients receiving the intervention in home vs practice settings. Conclusions and Relevance: An intervention directed by patients' needs and barriers improved asthma outcomes and self-management behaviors among older adults. Trial Registration: ClinicalTrials.gov identifier: NCT02316223.
AB - Importance: Older adults with asthma have worse control and outcomes than younger adults. Interventions to address suboptimal self-management among older adults with asthma are typically not tailored to the specific needs of the patient. Objective: To test the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes. Design, Setting, and Participants: Three-arm randomized clinical trial conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City. Adults 60 years and older with persistent, uncontrolled asthma were identified from electronic medical records at an academic medical center and a federally qualified health center. Of 1349 patients assessed for eligibility, 406 met eligibility criteria, consented to participate, and were randomized to 1 of 3 groups: home-based intervention, clinic-based intervention, or control (usual care). A total of 391 patients received the allocated treatment Interventions: Screening for psychosocial, physical, cognitive, and environmental barriers to asthma control and self-management with actions to address identified barriers. The intervention was delivered in the home or primary care practices by asthma care coaches. Main Outcomes and Measures: Primary outcomes were the Asthma Control Test, Mini Asthma Quality of Life Questionnaire, Medication Adherence Rating Scale, metered dose inhaler technique, and emergency department visits for asthma care. Primary analyses compared intervention (home or clinic based) with usual care. Results: Of the 391 patients who received treatment, 58 (15.1%) were men, and the mean (SD) age was 67.8 (7.4) years. After accounting for baseline scores, scores on the asthma control test were better in the intervention groups vs the control group (difference-in-differences at 3 months, 1.2; 95% CI, 0.2-2.2; P =.02; 6 months, 1.0; 95% CI, 0.0-2.1; P =.049; 12 months, 0.6; 95% CI, -0.5 to 1.8; P =.28; and overall, χ2 = 13.4, with 4 degrees of freedom; P =.01). Emergency department visits were lower at 12 months for the intervention groups vs the control group (16 [6.2%] vs 17 [12.7%]; P =.03; adjusted odds ratio, 0.8; 95% CI, 0.6-0.99; P =.03). Statistically significant improvements were observed for the intervention vs control patients in quality of life (overall effect: χ2 = 10.5, with 4 degrees of freedom; P =.01), medication adherence (overall effect: χ2 = 9.5, with 4 degrees of freedom; P =.049), and inhaler technique (metered-dose inhaler technique, correctly completed steps at 12 months, median [range]: 75% [0%-100%] vs 58% [0%-100%]). No significant differences in outcomes were observed between patients receiving the intervention in home vs practice settings. Conclusions and Relevance: An intervention directed by patients' needs and barriers improved asthma outcomes and self-management behaviors among older adults. Trial Registration: ClinicalTrials.gov identifier: NCT02316223.
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U2 - 10.1001/jamainternmed.2019.1201
DO - 10.1001/jamainternmed.2019.1201
M3 - Article
C2 - 31180474
AN - SCOPUS:85067030701
SN - 2168-6106
VL - 179
SP - 1113
EP - 1121
JO - JAMA internal medicine
JF - JAMA internal medicine
IS - 8
ER -