Adult Asthma Disease Management: An Analysis of Studies, Approaches, Outcomes, and Methods

Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27701, USA.
Respiratory care (Impact Factor: 1.84). 08/2009; 54(7):878-86. DOI: 10.4187/002013209793800385
Source: PubMed

ABSTRACT Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies.
We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods.
Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective.
Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.

1 Read
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Our nation is in the midst of an important debate on health care. The issues revolve around affordability, accessibility, quality and funding. Of these issues, the one that all experts agree must be resolved for the good of the country is the high cost of healthcare. Supported by years of testing and overwhelming empirical evidence by independent research, the MedEncentive Program has surfaced as a real breakthrough in resolving the issue of healthcare afforda- bility. This report presents the findings from five years of testing and the independent research that vali- dates the Program's efficacy and its underlining design principles. Background - From 1997 through 2007, a small group of innovators consisting of practicing physicians, a medical academician, a self-insured business owner, a medical practice management consultant, and a health insurance executive sought to find ways to align the interests of healthcare consumers, providers and insurers. After years of studying the issues, the group concluded that the single most pressing problem in healthcare was affordability. Understanding that the majority of healthcare costs are driven by people's poor health habits and medical provid- ers' variable practice patterns, the group focused on using incentives to align these stakeholders' interests to improve both health behaviors and practice patterns. This thought process led to the development of what would become a web-based incentive system called MedEncentive.
  • Source
    Respiratory care 08/2009; 54(7):844-6. DOI:10.4187/002013209793800295 · 1.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Asthma is a chronic respiratory disease increasingly prevalent in the U.S., particularly among children and certain minority groups. This umbrella review sought to assess and summarize existing systematic reviews of asthma-related interventions that might be carried out or supported by state or community asthma control programs, and to identify gaps in knowledge. Eleven databases were searched through September 2010, using terms related to four concepts: asthma, review, intervention, and NOT medication. Reviews of the effectiveness of medications, medical procedures, complementary and alternative medicine, psychological interventions, family therapy, and nutrients or nutritional supplements were excluded. Two coders screened each record and extracted data from the included reviews. Data analysis was conducted from May to December 2010. Of 42 included reviews, 19 assessed the effectiveness of education and/or self-management, nine the reduction of indoor triggers, nine interventions to improve the provision of health care, and five examined other interventions. Several reviews found consistent evidence of effectiveness for self-management education, and one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective for children. Other reviews found limited or insufficient evidence because of study limitations. State or community asthma control programs should prioritize (1) implementing interventions for which the present review found evidence of effectiveness and (2) evaluating promising interventions that have not yet been adequately assessed.
    American journal of preventive medicine 04/2012; 42(4):403-10. DOI:10.1016/j.amepre.2011.11.016 · 4.53 Impact Factor
Show more