Improving Asthma Care in Disadvantaged Elderly: A Randomized, Controlled Trial Using Telephone Intervention Conducted by Non-Medically Trained Personnel

Abstract

RATIONALE: Several studies suggest that asthma is under-treated in the elderly population. Our hypothesis is that asthma care in elderly subjects can improve using a telephone based intervention with non-medically trained personnel.METHODS: Fifty-two elderly, disadvantaged asthmatics who used rescue inhalers more than twice a week and had at least 1 ER or urgent care visit in the last year were randomized to a control or intervention group. Intervention consisted of 2 phone calls over a 12 month period by a non-medically trained person asking asthma specific questions. Subjects were encouraged to discuss asthma care with their physician. The control group received 2 phone calls asking general health questions. Medication use, health care utilization, and asthma care were evaluated at the beginning and end of a 12 month period. Categorical data were analyzed by Chi Square and ordinal data by Wilcoxon Signed-Ranks Test.RESULTS: The study was completed by 23 control and 25 intervention subjects. Baseline demographic data were similar in both groups. After 12 months, 72% (n=18) of the intervention group was on an inhaled corticosteroid compared to 40% (n=10) of the control group (p=0.05). The intervention group had fewer ER visits per patient when compared to the control group (0.28 vs. 0.48, p=0.03). At the end of the study, 64% (n=16) of the intervention group had an asthma action plan compared to 26% (n=6) of the control group (p=0.02).CONCLUSIONS: This study suggests that asthma care in disadvantaged elderly can be improved using a telephone based intervention conducted by non-medically trained personnel. RATIONALE: Several studies suggest that asthma is under-treated in the elderly population. Our hypothesis is that asthma care in elderly subjects can improve using a telephone based intervention with non-medically trained personnel. METHODS: Fifty-two elderly, disadvantaged asthmatics who used rescue inhalers more than twice a week and had at least 1 ER or urgent care visit in the last year were randomized to a control or intervention group. Intervention consisted of 2 phone calls over a 12 month period by a non-medically trained person asking asthma specific questions. Subjects were encouraged to discuss asthma care with their physician. The control group received 2 phone calls asking general health questions. Medication use, health care utilization, and asthma care were evaluated at the beginning and end of a 12 month period. Categorical data were analyzed by Chi Square and ordinal data by Wilcoxon Signed-Ranks Test. RESULTS: The study was completed by 23 control and 25 intervention subjects. Baseline demographic data were similar in both groups. After 12 months, 72% (n=18) of the intervention group was on an inhaled corticosteroid compared to 40% (n=10) of the control group (p=0.05). The intervention group had fewer ER visits per patient when compared to the control group (0.28 vs. 0.48, p=0.03). At the end of the study, 64% (n=16) of the intervention group had an asthma action plan compared to 26% (n=6) of the control group (p=0.02). CONCLUSIONS: This study suggests that asthma care in disadvantaged elderly can be improved using a telephone based intervention conducted by non-medically trained personnel.