Patient-tailored self-management support intervention controls asthma better, apart from improving the quality of life, medication adherence, and inhaler technique, according to the Mount Sinai study.
Asthma affects 7 percent of Americans older than 65 and causes more symptoms and hospitalizations in this age group than in younger patients with asthma. While experts have called for interventions specifically targeting this population, few relevant studies have been reported. Mount Sinai and other institutions tested the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes.
This study was conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City. It is also the first study to screen patients for barriers to control of their asthma, including social determinants of health, and target only the identified barriers for intervention.
The study was conducted by the Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York; Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago; Department of Psychology, The Graduate Center, City University of New York; City Health Works, New York; Institute for Family Medicine, New York; Little Sisters of the Assumption Family Health Service, New York; Department of Psychology, Hunter College, City of New York.
It was published with the Title: 'Effect of a self-management support intervention on asthma outcomes in older adults: The SAMBA Study randomized clinical trial.'
Older adults receiving a patient-tailored self-management support intervention for asthma, whether in the home or clinic, achieved meaningful improvements in asthma control and quality of life, self-management behaviors, and reductions in ED visits compared to patients in usual care. By specifically targeting social determinants of health and other drivers of health-related behaviors, the intervention is a promising model of self-management support and disease control for older adults with asthma, and possibly other chronic diseases.
"Health systems, insurers, and policymakers are increasingly recognizing the powerful influence of social factors on health and outcomes of health like hospitalizations and health care spending. Despite gaining more attention, few studies have tested ways of providing health care that address these social determinants of health. This newly developed approach is helping people with complex health problems, in this case older adults with asthma. By screening patients for barriers to controlling their asthma and addressing the barriers that were identified, the new program helped these older adults take their medications regularly, improve their control of asthma, and reduce their visits to emergency departments by more than 50 percent." Said Mount Sinai's Dr. Federman.