Does portal use and home visits improve asthma control?
Published online: June 7, 2019
Portals allow patients to access parts of their medical record, review test results, make appointments, request refills, and provide a secure platform for electronic messaging with providers. In an era of electronic records and internet-based digital devices, it is unknown whether portals can improve asthma outcomes. In particular, it is not known if portals help patients at disproportionately high-risk for poor asthma outcomes: low-income and minority adults. Research recently published in The Journal of Allergy & Clinical Immunology (JACI) examines whether a portal is easily accessed and used by such patients. It also examines whether health outcomes like hospitalizations, emergency department visits, symptoms, medication requirements, and asthma-related quality of life improve with portal use.
Apter et al recruited 301 adults with uncontrolled asthma living in low-income urban neighborhoods who were patients of an asthma specialty or primary care practice. These patients were shown how to access a portal and use it. Half were randomized to receive home visits by community health workers (CHWs) who would review and encourage use of the portal. CHWs would also encourage care coordination.
170 (56%) patients used the portal independently. Rates of portal activity did not differ between groups who did or did not receive home visits. Asthma control and asthma-related quality of life improved in both groups over one year. Differences in improvements over time were greater for the home visit group for all outcomes, but reached conventional levels of statistical significance only for the yearly hospitalization rate. Poor neighborhoods and living conditions plus limited internet access were barriers for patients to complete the protocol and for community health workers to make home visits.
For low-income urban adults with uncontrolled asthma, portal access and community health worker visits produced only small improvements in patient-centered outcomes. Home visits by CHWs with emphasis on self-management education rather than portal use or empowered to address neighborhood conditions might be necessary to facilitate patient-clinician communication and to improve outcomes for asthma.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.