A Low-Resource Intervention to Improve Patient Engagement in Asthma

Published online: May 10, 2017

Asthma is a common medical condition that frequently results in serious health problems for patients and expensive resource utilization for health systems. Worse outcomes have been seen in low-income and minority patients in part due to barriers accessing and engaging with health care. In many cases, appropriate medical care and medications may possibly prevent serious complications and consequences of asthma. Thus, ensuring that patients are able to access and utilize available medical resources is an important target for intervention to potentially improve outcomes in low-income and minority patients with moderate to severe asthma. As a similar social paradigm is seen broadly across many medical conditions, improving patient engagement could have a significant impact in clinical outcomes in a myriad of patient populations.

As described in The Journal of Allergy and Clinical Immunology: In Practice, the Helping Asthma Patients 2 (HAP2) trial led by Dr. Andrea Apter developed a patient advocate program to educate about and assist with navigating access to care and provider-patient communication. Patients in the ongoing study are from low-income or minority backgrounds and have moderate to severe asthma. Half of the participants were randomly assigned to receive the patient advocate’s assistance, while the remaining participants received usual care from their physicians. All participants, regardless of group assignment, were contacted by study personnel to complete questionnaires and follow up visits. Questionnaires included questions about knowledge of inhaled corticosteroids, an essential medication for moderate or severe asthma, inhaler technique, and basic asthma facts. Incorrect answers were reviewed and corrected. At the final research encounter 12 months after study enrollment, an open-ended End of Study Questionnaire was administered to investigate participants’ experience with the study.
In the current study, Korwin and colleagues conducted a qualitative analysis of the responses from the first 102 participants to complete the study, identifying emerging themes and the similarities and differences between response patterns of participants who had received patient advocate assistance and those who had received usual care.

All participants across both groups enjoyed participating in the study, and they endorsed four common themes: (1) appreciation of interpersonal and educational interaction, (2) perception of improved health care adherence, (3) preparedness for physician appointments, (4) improved patient-provider communication. Participants in both groups unanimously appreciated attention from study personnel and review of asthma-related information, as was provided during follow up research encounters. Taken together, these responses suggest that the minor intervention of interacting with the study staff in addition to the patient’s usual care team and receiving a brief educational session empowered patients' active health care participation.

In this study, patient engagement and empowerment were elicited by perceived education and personal attention. This study suggests a low-resource and easily implemented method to improve patient engagement. While this study focused specifically on patients from low socioeconomic or minority backgrounds with moderate to severe asthma, improving patient engagement remains an important target for future research across patients of all demographic backgrounds and with many medical conditions. This study also suggests that future investigation of the effect on health outcomes with implementation of this type of program to improve patient engagement is warranted.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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