Asthma "coaches" keep kids out of the hospital

NEW YORK (Reuters Health) - Community health workers acting as asthma coaches are able to reduce the need for rehospitalization for asthma episodes among children in low-income families, researchers report in the March issue of the Archives of Pediatrics and Adolescent Medicine.

A population-based study of 191 African American children between 2 and 8 years of age covered by Medicaid who were hospitalized for asthma was conducted by Dr. Edwin B. Fisher of the University of North Carolina at Chapel Hill and colleagues. The children were randomly assigned to usual care or to work for 2 years with an asthma coach.

Coaches reinforced basic asthma education and positive behaviors to manage the disease on home visits and by phone calls. Teaching was tailored to the parents' "readiness to adopt management practices." Coaches used a "nondirective supportive style."

"The coach offers help in figuring out how to implement in daily life the action plan developed in the physician's office," Fisher explained in an interview with Reuters Health. "In this sense, the fact that the coach is familiar with the neighborhood and circumstances of the parent and child and has time to 'brainstorm' with the parent about how to implement the plan is a great advantage."

He added, "The coach doesn't need expertise, just basic familiarity with the terms of an action plan and the time and good communication skills to work effectively with the parent."

There was an average of 21.1 contacts per parent over the 24 months of the intervention. During the first 3 months, 89.6 percent of parents had at least one contact with the coach.

Thirty-five of 96 children (36.5 percent) assigned an asthma coach were rehospitalized with asthma compared with 55 of 93 children (59.1 percent) who received usual care.

"The 52 percent reduction in hospitalization (average admissions per child, 0.73 in the coached and 1.52 in usual care group) is comparable with the effect of interventions implemented by professionals," the investigators report.

While there was no reduction in visits to the emergency department (ED) in this study, there was a reduction in the need for hospitalization following an ED visit in the coached group, suggesting "acuity at arrival for emergency care may be reduced by having learned to initiate treatment before emergency care or to seek emergency care earlier."

SOURCE: Archives of Pediatrics and Adolescent Medicine, March 2009.