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Asthma coaching of older patients improves quality of life and self-management (SAMBA)
Question clinique
Can asthma care coaching aimed at supporting self-management improve outcomes in older patients with asthma?
L’Essentiel
Using an asthma care coach—a high school or college graduate trained to identify barriers to asthma self-management and address them—improved quality of life and decreased emergency department visits over 1 year. The program, called Supporting Asthma Management Behaviors in Adults, is described at www.SAMBAforAsthma.com. 1b
Référence
Plan de l'etude: Randomized controlled trial (single-blinded)
Financement: Foundation
Cadre: Outpatient (primary care)
Sommaire
These investigators recruited 391 adults at least 60 years of age with uncontrolled moderate or severe asthma from 9 primary care practices, excluding patients with other pulmonary diseases or more than a 15 pack-year smoking history. The patients were randomized, allocation concealment uncertain, to remain in usual care or to receive the intervention either at home or in the office. The intervention comprised 3 elements delivered by an asthma care coach: (1) identifying barriers to asthma self-management, (2) targeted actions to address these barriers, and (3) reinforcement over time. Over 1 year, this coaching improved asthma-related quality of life, and emergency department visits occurred less often in patients who received the intervention (odds ratio = .8; 95% CI .6 - .99). Asthma control scores and inhaler technique were both improved in the intervention groups. The intervention was equally effective when provided in the office or at home.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA