March 2009 issue
Patients with chronic illness must learn to recognize signs, symptoms, and triggers that exacerbate their condition. Then, they must proactively implement self-care techniques to best manage those symptoms and crises. While physicians prescribe medicines, draw up plans of care and provide instructions for these plans, low health literacy among many patients combined with time compressed office visits often leave patients bewildered when it comes to effectively managing their disease. In a randomized controlled study, Dr. Fisher and his colleagues at UNC at Chapel Hill used asthma coaches in a population of African American children with asthma to bolster health literacy and improve clinical outcomes. Community health workers familiar with the medical terms of an action plan, with good communication skills and the ability to work effectively with parents, served as asthma coaches. Using a coaching style that was both cooperative and supportive, home visit and phone call interventions were tailored to parents’ readiness to adopt the management practices. A coach’s job was to reinforce basic asthma education and encourage key behaviors for managing the disease. Through randomization, the patients received usual care or usual care with the addition of an asthma coach. Over the 24 months of the study, coaches averaged 21.1 contacts with the families. Among the asthmatics receiving this care, 36.5% were hospitalized subsequent to an emergency department visit compared to the 59.1% hospitalized subsequent to an emergency department visit for the asthmatics receiving usual care, a statistically significant difference between the two groups. In the March edition of the Archives of Pediatrics and Adolescent Medicine, Fisher and his colleagues published their findings,
“An asthma coach can reach low-income parents of African American children hospitalized for asthma and reduce rehospitalization among the children.”
As health care professional continue to excel in working effectively as a team in the delivery of care, the use of asthma coaches may be one option for improving health literacy and self-care while reducing the morbidity caused by asthma.
Read the Abstract:
Fisher EB, Strunk RC, Highstein GR, Kelley-Sykes R, Tarr KL, Trinkaus K, Musick J. A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Arch Pediatr Adolesc Med. 2009 Mar;163(3):225-32. Available at http://www.ncbi.nlm.nih.gov/sites/entrez
