Published Online: October 30, 2014
On average, asthma affects one in ten children in the United States, but is more common and more problematic in low-income children. Effective treatments are available but are underused and many children with asthma have symptoms that limit their activities, as well as exacerbations that result in missed school, missed work, Emergency Department (ED) visits and hospitalization. In children, asthma is managed primarily by the parent in partnership with the primary care provider. Effective asthma management is complex and requires the parent to give daily medications, monitor the child’s symptoms, know when and how to augment treatment or seek help when symptoms worsen, and communicate with multiple care providers. Many parents opt instead to manage asthma as an episodic illness with ED visits as needed and few office visits to optimize preventive treatment. Now, in a study recently published in The Journal of Allergy and Clinical Immunology, J. Garbutt and colleagues present the results of a large study evaluating a novel approach to improving asthma management – a peer-training program for parents of children with asthma that was delivered exclusively by telephone.
The authors of this study evaluated 948 families for two years. Twenty-two pediatric practices were divided into two groups. In both groups, families with a child aged 3-12 years of age with asthma received usual asthma care from their pediatrician. In addition, families in one group had access to a peer-trainer via telephone. During a series of brief calls over 12-months, the peer-trainer provided the parent tailored education, skill training, and support for asthma management behaviors. Measurement of symptom-free days and ED visits were compared at the end of the 12-month peer-training program and again at 24-months.
With this design the authors were able to demonstrate that the program was well accepted by parents and physicians and had an overall positive effect. After an average of four hours of peer training over 12-months, children in the peer-training group had three more weeks without asthma symptoms than children in the other group. Children with Medicaid insurance showed a similar reduction in asthma symptoms and also experienced 42% fewer ED visits and 62% fewer hospitalizations, and these reductions in healthcare use endured through 24-months.
This study identifies an effective, pragmatic approach to augment community-based asthma care and improve asthma outcomes. It also suggests that this telephone-based peer-training program for parents may be an effective strategy to reduce disparities in asthma outcomes.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAI, and is the most-cited journal in the field of allergy and clinical immunology.