Community-based interventions in asthma

Worldwide asthma epidemiology: insights from the Global Health Data Exchange database

BACKGROUND

Enhanced focus on primary care provision is essential for lowering the risk of asthma exacerbation and complications, as well as for decreasing asthma-related hospitalizations and deaths. This article provides an update on current worldwide epidemiology of asthma.

METHODS

Worldwide epidemiologic information on asthma was obtained through electronic searches in the Global Health Data Exchange (GHDx) database.

RESULTS

In 2017, the incidence of asthma was 43.12 million new cases/year (0.56%), while in that same year, prevalence and mortality accounted for 272.68 million cases (3.57%) and 0.49 million deaths (0.006%), respectively. Although the number of asthma cases significantly increased during the last 25 years, disability-adjusted life years (DALYs) and deaths constantly declined. After adjustment of asthma incidence, prevalence, and DALYs for worldwide demographic variation, no significant changes could be seen during the last 25 years, while asthma mortality significantly declined during the same period. Asthma incidence peaks before the age of 5 years, whereas prevalence and DALYs peaks are observed between 0 and 14 years. DALYs also display a second peak, between 45 and 74 years. Asthma mortality increases with aging, reaching the peak after 80 years. The epidemiologic burden and mortality of asthma are constantly higher in women than in men. An inverse, highly significant correlation can be found between sociodemographic index and asthma incidence (r = -0.98) or mortality (r = -0.96).

CONCLUSION

Although the worldwide burden of asthma remains high, incidence and prevalence are not apparently translating into an escalating clinical and economic burden in terms of health loss and deaths.

Access to Resources in the Community Through Navigation: Protocol for a Mixed-Methods Feasibility Study

Background

Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual’s ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients.

Objective

This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach.

Methods

The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients.

Results

Enrollment is closed with 82 patients. Navigation services have ended for 69 patients.

Conclusions

The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial.

Trial Registration

ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl)

International Registered Report Identifier (IRRID)

RR1-10.2196/11022