Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Massachusetts (cont'd)
Asthma Among Inner City Minorities - A Controlled Trial
Brigham and Women's Hospital
Jacqueline Rodriguez-Louis, MPH, Med
The "Asthma Among Inner City Minorities - A Controlled Trial" was a study implemented by Brigham and Women's Hospital in 1990 in Boston, MA. The study targeted low-income adults, 18-54 years, living in inner-city Boston. Most of these adults were minorities. Two components of the study were patient education with home visits, and provider education sessions.
The patient education and home visits were conducted by a health educator. The health educator conducted an initial 1 1/2 hour home visit that included a visual assessment of the patient's home and asthma education (e.g., pathophysiology, medication use, and triggers). The health educator would also review the patient's medical chart for additional information. Follow-up visits were conducted at 6mos, 12mos, and 24mos.
The provider education component were center-based seminars held at participating neighborhood centers (where the patients were recruited). The principal investigator provided healthcare updates regarding asthma, mediations, and the Guidelines during the sessions. The Health Educator would then provide information regarding what the patients were receiving in the patient education visits, feedback and information on chart documentation, deficiencies in care, medications, and treatment of asthma patients at different severity levels. These sessions occurred initially and then annually. The sessions were 1-1 1/2 hours in length.
Preliminary data revealed positive impacts on emergency department visits, medication use (inhaled corticosteroids), change in medical treatment plan (corticosteroid prescriptions), lung function (spirometry), and use of a PFM at home (results recorded in a diary). The program also improved knowledge, confidence in self management skills, and self efficacy. Environmental triggers were measured via self report, observation, and chart review. Improved triggers were dust mites, outdoor allergens inside the home, mold, and ETS.
The trial (completed in 1999) has evolved into BWH Community Asthma Program (CAP), a broad community-based, asthma awareness program. CAP is co-managed by Jacqueline Rodriguez-Louis, MPH, M.Ed. and Christopher Fanta, M.D. at BWH Pulmonary Division. CAP is oriented toward increasing community awareness and, through this increased awareness, affect norms regarding asthma, motivate community action for social and physical environmental changes, and bring more people onto asthma care.
Currently CAP conducts asthma education programs and trainings on an individual and community level, provides collegial support and medical updates on asthma for physician and nurses at Brigham-affiliated Neighborhood Health Centers, and develops culturally appropriate educational materials.
Page 80 of 223