Asthma Adherence Monitoring with Feedback

OVERVIEW

The Asthma Adherence Monitoring with Feedback (AMF) program is a five-week home-based asthma education program for children aged 2-12. Families receive home visits from a trained asthma educator. During these home visits, families also receive feedback of medication adherence and are encouraged to set goals for controlling asthma and adhering to using asthma medications, among other services. An evaluation found a greater decrease in emergency department visits and greater increase in ICS refills among the AMF group compared with the control group.

DESCRIPTION OF PROGRAM

Target population: Children aged 2-10 with asthma residing in an inner-city area.

The Asthma Adherence Monitoring with Feedback (AMF) program is a five-week home-based asthma education program. Families receive home visits from a trained asthma educator at one, two, three, four, and eight weeks after program enrollment. During home visits, the asthma educator covers five main program components: review of physician-prescribed asthma regimen and training in medication, spacer, and peak flow methods; develop an asthma action plan; identify family barriers to accessing healthcare and develop problem-solving strategies to reduce these barriers; discuss beliefs and concerns about asthma and medications; and provide written asthma education materials to the family. Family home visits generally last 30- to 45-minutes.

Additionally during these home visits, families also receive feedback on medication adherence through the use of electronic monitors; families are encouraged to set goals for controlling asthma and adhering to using asthma medications; reinforcing medication adherence goals; and establishing self-monitoring medication use by developing behavioral charts and a diary of asthma symptoms.

Asthma educators receive training to provide supportive, nonthreatening encouragement and feedback to families. Asthma educators work with families to establish age-appropriate goals for children’s asthma self-management. When children achieve adherence goals, they are rewarded with small items such as crayons; when goals are not achieved, the asthma educator works with the family to identify barriers and develop problem-solving strategies. Along the way, the asthma educators work with family to identify improvements in adherence and asthma outcomes.

A second arm of this study included a randomized group of participants who received asthma basic care services (ABC), which provided education but did not include the focus on adhering to asthma medications. This arm of the intervention, along with the findings, is separately written up and posted on the LINKS’ website.

EVALUATION(S) OF PROGRAM

Otsuki M, Eakin MN, Rand CS, Butz AM, Hsu VD, Zuckerman IH, Ogborn J, Bilderback A, Riekert KA. (2009). Adherence Feedback to Improve Asthma Outcomes Among Inner-City Children: A Randomized Trial. Pediatrics, 124(6):1513-1521.

Evaluated population: A total of 166 families were randomized to either the AMF intervention or control group. The mean age as seven years. Among the AMF intervention group, 54% were male, 81% were black, 74% were insured through Medicaid, 83% had a regular source for nonurgent asthma care, 22% live with a smoker in the home, and 33% lived in a household with an annual income below $10,000.

Approach: Study participants were recruited into the study, by telephone, after reviewing emergency department discharge records. Children were randomly assigned to the AMF intervention group (n=83) or control group (n=83). Children were eligible for the study if they were between two and 12 years of age, diagnosed with asthma by a physician, had two asthma-related emergency department visits or hospitalizations within the past year, were prescribed an asthma controller medication, and resided in Baltimore, MD.

Children assigned to the control group received asthma education information such as a booklet and a resource guide; the resource guided provided information about low-cost asthma care providers, social services, legal services, as well as other resources.

Participants and families were assessed at six, 12, and 18 months after study assignment on the following: self-reported medication adherence, number of refills for inhaled corticosteroids (ICS), and asthma morbidity (cough, wheeze, shortness of breath, or chest tightness/discomfort, nighttime awakenings, emergency department visits, and courses of oral corticosteroids in the previous six months.)

Results: At follow-up assessments, there was a 15 per cent greater decrease in emergency department visits over six months and a 52 per cent greater increase in ICS refills among the AMF group compared with the control group. There was a marginally significant difference in use of corticosteroids among those in the intervention group compared with the control group. However, there were no differences between the two study groups on asthma symptom frequency or hospitalizations.

An additional analysis compared the AMF intervention group with the ABC intervention group and found no significant differences on any outcome between the two groups.

SOURCES FOR MORE INFORMATION

SUMMARY & CATEGORIZATION

Evaluated participant ages: Children (3-11)

Program components: Home-based

Measured outcomes: Physical Health

KEYWORDS: Children (3-11), Home-based, Home Visitation, Parent/Family Component, Black/African-American, Other Physical Health

Program information last updated 9/24/10.

		© Child Trends 2003