Effectiveness of Home Visits in Adult Patients with Asthma: A Systematic Review of Randomized Controlled Trials

The effect of a nurse-led home visit program on the care burden of caregivers of adults with asthma: A randomized controlled trial

OBJECTIVE

This study aimed to determine the effect of a home visit program on the perceived care burden of family caregivers of adults with asthma.

DESIGN

A single-blind randomized controlled trial.

SAMPLE

The study was conducted with 30 participants in both the intervention and control groups.

MEASUREMENTS

Care burden was measured via the Zarit Caregiver Burden Scale during the first interview at the pulmonology outpatient clinic and after the last home visit.

INTERVENTION

A nurse-led home visit program with five visits over three months included education and health counseling with the intervention group. Control group received standard education given in the outpatient clinic.

RESULTS

The mean Zarit Caregiver Burden Scale scores of the intervention group in the post-test were significantly lower than the control group.

CONCLUSIONS

The current study revealed that the nurse-led home visit program, including education and health counseling, was effective in reducing the care burden for family caregivers of adults with asthma. Nurses can play an active role in preventing the negative effects of caregivers' burden of care, protecting their sense of control, and improving their health. Home visits integrated into the health care system could be effective in reducing the care burden of family members.

Effectiveness of home visit nursing on improving mortality, hospitalization, institutionalization, satisfaction, and quality of life among older people: Umbrella review

This umbrella review followed the JBI methodology and synthesized systematic reviews of the effectiveness of long-term home visit nursing for older people (≥ 60 years) on improving mortality, hospitalization, institutionalization, patient satisfaction, and quality of life. Eight bibliographic databases were searched, and 10 reviews with 22 distinct relevant trials (n = 10,765 participants) were included. Mortality was the most frequently examined outcome and satisfaction was the least examined (n = nine and one reviews, respectively). Home visit nursing had a favorable effect on reducing the number of admissions to hospital (n = 1,152 participants in two trials vs. 788 participants in three trials) and no effect on other outcomes. The evidence of the effectiveness of long-term home visit nursing for older people is minimal. Future research needs to be based on a theoretical foundation that explains how interventions are expected to work.

The Effect of a Theory of Planned Behavior Education Program on Asthma Control and Medication Adherence: A Randomized Controlled Trial

BACKGROUND

Disease management in individuals with asthma is affected by factors such as avoiding triggers that cause attacks and properly using inhaler devices.

OBJECTIVE

To determine the effect of a theory of planned behavior (TPB) education program on asthma control and medication adherence.

METHODS

A randomized controlled trial enrolled 30 participants in the intervention group and 30 in the control group. The educational approach was employed in participants in the intervention group for five home visits over 3 months according to the TPB program.

RESULTS

Before the education program, all participants in the intervention group and 90% of those in the control group had poorly controlled asthma (P > .05). After the program, all individuals in the intervention group and 20% of the control group had well-controlled asthma (P < .001). There was no statistically significant difference between Morisky Medication Adherence Scale-8 pretest scores in the intervention and control groups in terms of medication adherence (2.37 ± 1.75 and 3.13 ± 1.71, respectively; P > .05). Mean Morisky Medication Adherence Scale-8 scores in the intervention group at posttest (7.50 ± 0.78) were significantly higher than those of the control group (3.93 ± 2.03; P < .001.

CONCLUSIONS

This study revealed that asthma control and medication adherence increased in the intervention group after the TPB education program. The program was effective in asthma control and medication adherence for individuals with asthma.

The Association Between Beliefs and Adherence to Inhaled Controller Medication Among Older Adults with Asthma: A Cross-Sectional Study in Primary Care

BACKGROUND

While illness perceptions and medication beliefs have been shown to be associated with inhaled corticosteroid (ICS) adherence in younger adults with asthma, their impact on older adults is less understood. This study aimed to determine the prevalence of ICS adherence among older Asian adults and to assess the association between ICS adherence, illness perceptions and medication beliefs.

METHODS

A questionnaire survey on older multi-ethnic Asian patients, aged ≥60 years, with physician-diagnosed asthma, was conducted in two Singapore public primary care clinics. The scores of the Medication Adherence Report Scale for asthma (MARS) were computed to determine the adherence to ICS alone or in combination with LABA. Illness perceptions and medication beliefs were assessed by the scores from the Brief-Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ), respectively. Logistic regression analyses were used to identify factors associated with ICS adherence.

RESULTS

Analyses of 323 participants (57% males; Chinese 73.7%, Malay 12.7%, Indian 12.4%; mean age 71.5 years) showed that 40.9% of them had good adherence to ICS (mean MARS score≥4.5). Good adherence to ICS was associated with perception of asthma as a chronic illness (OR=1.22; 95% CI=1.10-1.35; p<0.001), belief of ICS as an essential medication (2.67; 1.76-4.06; p<0.001) and fewer concerns about its use (0.39; 0.26-0.60; p<0.001). Patients on combined ICS-LABA therapy had higher adherence (2.50; 1.41-4.44; p=0.02) than those on ICS monotherapy.

CONCLUSION

Four in ten older patients with asthma were adherent to ICS. Perception of medication necessity, chronicity of illness, concerns and use of ICS-LABA medication were associated with adherence.