Patient Advocates for low-income adults with moderate to severe asthma
Published online: July 13, 2020
Asthma disproportionately impacts low-income and minority adults, particularly African Americans and Puerto Ricans. Few research trials have targeted these adults, even though they are the group of patients most likely to die from asthma. In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Apter and colleagues examined whether a Patient Advocate (PA) could be utilized to improve asthma control for our patients since PAs had been well accepted by patients in prior studies.
The PA in this study was a college graduate interested in a health care career. The PA role was developed from patient and clinician advice: the PA coaches, models, and assists participants with preparations for asthma-related medical visits, attends visits, and confirms participants’ understanding of all clinician’s recommendations. Participants were adults with moderate to severe asthma from primary care and asthma specialty practices serving low-income neighborhoods. We randomized patients for 6 months of the PA intervention or usual care, observed both groups for an additional 6 months, and recorded patient-relevant events: asthma control (primary outcome), quality of life, prednisone requirements, emergency department visits, and hospitalizations.
There were 312 participants. The mean age was 51 years (range 19-93 years); 69% were women, 66% were African American, 8% were Hispanic/LatinX; 21% had diabetes, 61% were obese, and 54% had hypertension. Asthma control improved over 12 months in both groups, but the difference between groups was not statistically significant. The rate of emergency department (ED) visits and hospitalizations decreased in both groups. The decrease in ED visits was approximately twice the decline in the PA compared with the usual care group. However, this difference did not reach conventional levels of statistical significance. Only 4% dropped out of the study. Of 156 randomized to the PA group, 63% had at least 1 medical appointment with PA support, but half of these had only 1 visit. Fifteen patients had more than two visits. The cost of the Patient Advocate program was $1521 per patient.
A PA may be a promising intervention to improve and sustain outcomes in this high-risk population if expanded to address factors that make keeping appointments difficult.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.