Program

Jan 28, 2013

OVERVIEW

The Asthma Adherence Monitoring with Feedback (AMF) program is a five-week home-based asthma education program for children aged 2 to 12. Families receive home visits from a trained asthma educator. During these home visits, families receive feedback on 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 inhaled corticosteroid refills among the AMF group when compared with the control group.

DESCRIPTION OF PROGRAM

Target population: Children aged 2 to 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, asthma educators provide families with feedback on medication adherence through the use of electronic monitors; encourage families to set goals for controlling asthma and adhering to using asthma medications; reinforce medication adherence goals; and establish self-monitoring medication use by developing behavioral charts and a diary of asthma symptoms.

Asthma educators receive training to provide supportive and 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 (e.g., crayons), and 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.

EVALUATION(S) OF PROGRAM

Otsuki, M., Eakin, M. N., Rand, C. S., Butz, A. M., Hsu, V. D., Zuckerman, I. H., . . . Riekert, K. A. (2009). Adherence feedback to improve asthma outcomes among inner-city children: A randomized trial. Pediatrics, 124(6), 1513-1521.

Evaluated population: A total of 250 children aged 2 to 12 were evaluated. Children were eligible for the study if they were 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.

The mean age was 6.5 years. Among the AMF intervention group, 65 percent were male, 98 percent were black, 89 percent were insured through Medicaid, 100 percent had a regular source for non-urgent asthma care, 26.8 percent lived with a smoker in the home, and 41.3 percent lived in a household with an annual income below $10,000.

Approach: Study participants were recruited into the study, by telephone through review of emergency department discharge records. Children were randomly assigned to the AMF intervention group (n=83) or usual care control group (n=83). Children assigned to the control group received asthma education information such as a booklet and a resource guide. The resource guide provided information on low-cost asthma care providers, social services, legal services, and other resources. The ABC intervention group received the same treatment as the AMF group without asthma medicine adherence monitoring and feedback.

A second arm of this study included a randomized group of participants who received asthma basic care services (ABC), which provided asthma education but did not 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 here.

Participants and families were assessed at six, 12, and 18 months after study assignment on the following outcomes: 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, hospitalizations, and courses of oral corticosteroids in the previous six months).

Results: At follow-up assessments, there was a 15 percent greater decrease in emergency department visits over six months and a 52 percent greater increase in ICS refills among the AMF group when compared with the control group. There was a marginally significant difference in decreased use of corticosteroids among those in the intervention group when compared with the control group. However, there were no differences between AMF and the control group 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

References:

Otsuki, M., Eakin, M. N., Rand, C. S., Butz, A. M., Hsu, V. D., Zuckerman, I. H., . . . Riekert, K. A. (2009). Adherence feedback to improve asthma outcomes among inner-city children: A randomized trial. Pediatrics, 124(6), 1513-1521.

KEYWORDS: Children (3-11), Home-based, Home Visitation, Parent/Family Component, Black/African-American, Health Status/Conditions, Males and Females, Adolescents

Program information last updated 1/28/13.