[ad_1]
According to a randomized trial, adapt the teaching of asthma and the use of drugs to the specific needs of elderly patients has significantly improved asthma control and adherence to treatment in adults over 60 years of age with a persistent and uncontrolled disease.
Half as many study participants in the individualized support group of the study reported an asthma hospital-related emergency visit compared to controls no Who had not received intervention support (6% versus 12%, respectively) during the 12-month follow-up, reported Alex Federman, MD, of Mount Sinai School of Medicine Icahn, New York. York, and his colleagues.
Statistically significant improvements were also observed for quality of life and inhalation technique in the intervention group, the authors wrote. JAMA internal medicine.
About 7% of people over the age of 65 in the United States have asthma and, as a group, older patients tend to have asthma control and poorer outcomes than other adult patients.
This is due, in part, to problems related to self-management of the disease, such as the inappropriate use of inhalers or the sub-optimal use of control drugs. Daily asthma, said Federman.
"Studies regularly show that only 30% to 40% of [older] patients regularly use drugs designed to control the disease, "he said. MedPage today.
Managing co-morbidities such as cardiovascular disease, diabetes, and high blood pressure also complicates the management of elderly patients with asthma.
Federman added that the treatment of asthma is often overlooked in elderly patients taking multiple medications for other chronic conditions.
Psychosocial, cognitive, physical and mental health problems can also complicate the treatment of asthma in elderly patients.
Most interventions to improve medication adherence for asthma focus on generalized asthma education and skills training, with limited adaptation to needs the patient, "wrote the authors. "Yet, a generalized approach to asthma education can cognitively overload older patients, diverting them from the information they need most to improve their care."
They developed an intervention to support asthma self-management in older patients, with a focus on screening for psychosocial, physical, cognitive and environmental barriers that may interfere with treatment.
To test the effectiveness of the patient-tailored support intervention, the researchers conducted a three-part randomized clinical trial called SAMBA (Self-Management Behaviors in Old Adults). It involved 406 patients aged 60 and over in New York suffering from persistent and uncontrolled asthma.
Patients were randomized to receive either home-based intervention, clinic intervention, or usual care without supportive intervention for self-management (control group).
During the initial visit, an asthma care coach conducted a screening badessment to identify three barriers to asthma care: a poor inhalation technique, intermittent use of fluticasone propionate and signs of badroach infestation at home. Targeted actions provided by the asthma care coach included training of patients in proper inhalation technique, asthma education focused on the chronic nature of the disease, and the different roles and uses of asthma medications. control and rescue.
Patients who cited the cost of drugs as a barrier to treatment were also asked to discuss cost issues with their doctor, and home pest patients were referred to city-sponsored pest control services. New York available for residents of low-income households.
During the 12-month follow-up, coaches met with patients intermittently and evaluated the inhalation technique, adherence to treatment, and addressed new problems as they arose.
The main findings of the study included improved asthma control, quality of life, and treatment adherence, as measured by the Asthma Control Test, the Quality of Life in Asthma Questionnaire, the Treatment Adherence Rating Scale, the metered dose inhalation technique, and asthma emergency room visits.
There were 391 patients included in the final badysis. The average age was about 68 years old and about 85% of the patients were women.
Among the main conclusions:
- Compared to baseline scores, asthma control test scores were better in the intervention groups compared to the control group (difference difference at 3 months, 1.2, 95% CI 0.2 to 2.2; P= 0.02 and 6 months, 1.0; 95% CI, 0.0-2.1; P= 0.049).
- Asthma-related visits to emergency departments were less frequent at 12 months in the intervention groups compared to the control group (6.2% vs. 12.7%; P= 0.03; adjusted odds ratio, 0.8; 95% CI, 0.6-0.99; P= 0.03).
- Quality of life scores were also better in the intervention group (overall effect: 2 = 10.5, with 4 degrees of freedom; P= 0.03), as well as treatment compliance (overall effect: 2 = 9.5, with 4 degrees of freedom); P= 0.049), and inhalation technique (measured dose inhalation technique, steps correctly completed at 12 months, median value) [range]75% [0%-100%] vs 58% [0%-100%]).
Home and clinic interventions did not have significantly different results.
The researchers noted that even though the study demonstrated the usefulness of patient-centered support and coaching, the findings "also highlighted the challenges badociated with the patient." commitment of self-management by vulnerable populations, including modest retention rates and reduced impact over time despite repeated encounters effects. "
"Future iterations of the intervention will test strategies to improve long-term retention and impact, and may include repeated screening of barriers, interventional matching of asthma coaches and patients." as well as a targeted development of skills with CCAs to improve their ability to mobilize patients and influence behaviors, "they wrote.
Funding for this research was provided by the Institute for Patient Focused Outcomes Research.
Principal Investigator Juan Wisnivesky stated that he received personal fees from Sanofi, Quintiles and Banook, as well as Sanofi and Quorum grants unrelated to this study.
2019-06-10T13: 30: 00-0400
Source link
