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Akinyemi O, Weldeslase T, Odusanya E, Fasokun M, Agboola B, Andine T, Ayeni E, Michael M, Hughes K. The relationship between neighborhood economic deprivation and asthma-associated emergency department visits in Maryland. FRONTIERS IN ALLERGY 2024; 5:1381184. [PMID: 38903705 PMCID: PMC11188351 DOI: 10.3389/falgy.2024.1381184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background Asthma represents a substantial public health challenge in the United States, affecting over 25 million adults. This study investigates the impact of neighborhood economic deprivation on asthma-associated Emergency Department (ED) visits in Maryland, using the Distressed Communities Index (DCI) for analysis. Methods A retrospective analysis of Maryland's Emergency Department Databases from January 2018 to December 2020 was conducted, focusing on asthma-associated ED visits. Results The study involved 185,317 ED visits, majority of which were females (56.3%) and non-Hispanic whites (65.2%). A significant association was found between increased neighborhood socioeconomic deprivation and asthma-related ED visits. The poorest neighborhoods showed the highest rates of such visits. Compared to prosperous areas, neighborhoods classified from Comfortable to Distressed had progressively higher odds for asthma-related ED visits (Comfortable: OR = 1.14, Distressed OR = 1.65). Other significant asthma predictors included obesity, female gender, tobacco smoking, and older age. Conclusion There is a substantive association between higher asthma-related ED visits and high neighborhood economic deprivation, underscoring the impact of socioeconomic factors on health outcomes. Public health implications Addressing healthcare disparities and improving access to care in economically distressed neighborhoods is crucial. Targeted interventions, such as community health clinics and asthma education programs, can help mitigate the impact of neighborhood disadvantage.
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Affiliation(s)
- Oluwasegun Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Terhas Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama, Birmingham, AL, United States
| | - Bukola Agboola
- Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD, United States
| | - Tsion Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Esther Ayeni
- Department of Geography and Meteorology, Ball State University, Muncie, IN, United States
| | - Miriam Michael
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC, United States
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
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van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1228-1243. [PMID: 38182099 DOI: 10.1016/j.jaip.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs. OBJECTIVE We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU). METHODS We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings. RESULTS Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. CONCLUSIONS Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
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Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Centre Groningen, Groningen, University of Groningen, Groningen, The Netherlands.
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Patino
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Bogdan Muresan
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
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Duszyk K, McDonald VM, Thomas D, Steel K, Gibson PG. The treatable traits of asthma in pregnancy: a clinical audit. ERJ Open Res 2024; 10:00748-2023. [PMID: 38887677 PMCID: PMC11181053 DOI: 10.1183/23120541.00748-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 06/20/2024] Open
Abstract
Rationale Poor asthma control in pregnancy is associated with adverse perinatal outcomes. Treatable traits improve patient outcomes but the pattern and prevalence of treatable traits in pregnant women with asthma is unknown. Whether treatable traits in pregnant women with asthma can be identified via a virtual care consult is also unknown. The objective of the present study was to assess the prevalence of treatable traits in pregnant women with asthma using a virtual model of care. Methods Pregnant women with asthma (n=196) underwent an assessment by an asthma nurse educator and a respiratory physician via telehealth. In this clinical audit, 16 treatable traits were assessed including two traits in the pulmonary domain, five traits in the behavioural/risk factors domain and nine traits in the extrapulmonary domain. Results Pregnant women with asthma had a mean±sd of 7.5±2.0 treatable traits per person including 1.0±0.7 treatable traits per person in the pulmonary domain, 3.5±1.56 in the extrapulmonary domain and 2±0.9 in the risk factor/behavioural domain. Treatable traits in the behavioural/risk factor domain were most prevalent and these included limited asthma knowledge (96%), inadequate inhaler technique (84%) and no written asthma action plan (80%). On average 3.8±1.24 interventions per person were delivered for a mean±sd of 7.5±2.0 treatable traits per person. Conclusion Virtual antenatal asthma care is a feasible approach for assessing treatable traits in pregnant women with mild asthma. Pregnant women with asthma exhibit multiple management issues. Virtual models of care might increase asthma in pregnancy service uptake and acceptability.
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Affiliation(s)
- Katarzyna Duszyk
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Vanessa Marie McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Kelly Steel
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Peter Gerard Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Molfino NA, Turcatel G, Riskin D. Machine Learning Approaches to Predict Asthma Exacerbations: A Narrative Review. Adv Ther 2024; 41:534-552. [PMID: 38110652 PMCID: PMC10838858 DOI: 10.1007/s12325-023-02743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
The implementation of artificial intelligence (AI) and machine learning (ML) techniques in healthcare has garnered significant attention in recent years, especially as a result of their potential to revolutionize personalized medicine. Despite advances in the treatment and management of asthma, a significant proportion of patients continue to suffer acute exacerbations, irrespective of disease severity and therapeutic regimen. The situation is further complicated by the constellation of factors that influence disease activity in a patient with asthma, such as medical history, biomarker phenotype, pulmonary function, level of healthcare access, treatment compliance, comorbidities, personal habits, and environmental conditions. A growing body of work has demonstrated the potential for AI and ML to accurately predict asthma exacerbations while also capturing the entirety of the patient experience. However, application in the clinical setting remains mostly unexplored, and important questions on the strengths and limitations of this technology remain. This review presents an overview of the rapidly evolving landscape of AI and ML integration into asthma management by providing a snapshot of the existing scientific evidence and proposing potential avenues for future applications.
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Affiliation(s)
- Nestor A Molfino
- Global Development, Amgen Inc., One Amgen Center Dr, Thousand Oaks, CA, 91320, USA.
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Kaplan A, Boivin M, Bouchard J, Kim J, Hayes S, Licskai C. The emerging role of digital health in the management of asthma. Ther Adv Chronic Dis 2023; 14:20406223231209329. [PMID: 38028951 PMCID: PMC10657529 DOI: 10.1177/20406223231209329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions. DHT and DT have been proven effective in enhancing patient self-management in other chronic conditions, particularly diabetes. Accelerated integration of DHT and DT into the management of asthma patients is facilitated by the use of digital inhalers that employ sensor technology ("smart" inhalers). These devices efficiently provide real-time feedback on controller adherence, SABA use, and inhaler technique that have the strong potential to optimize asthma control.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, 14872 Yonge Street, Aurora, Toronto, ON L4G 1N2, Canada
- Family Physician Airways Group of Canada, Markham, ON, Canada
| | | | | | - James Kim
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Christopher Licskai
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
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Emeryk A, Derom E, Janeczek K, Kuźnar-Kamińska B, Zelent A, Łukaszyk M, Grzywalski T, Pastusiak A, Biniakowski A, Szarzyński K, Botteldooren D, Kociński J, Hafke-Dys H. Home Monitoring of Asthma Exacerbations in Children and Adults With Use of an AI-Aided Stethoscope. Ann Fam Med 2023; 21:517-525. [PMID: 38012028 PMCID: PMC10681685 DOI: 10.1370/afm.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE The advent of new medical devices allows patients with asthma to self-monitor at home, providing a more complete picture of their disease than occasional in-person clinic visits. This raises a pertinent question: which devices and parameters perform best in exacerbation detection? METHODS A total of 149 patients with asthma (90 children, 59 adults) participated in a 6-month observational study. Participants (or parents) regularly (daily for the first 2 weeks and weekly for the next 5.5 months, with increased frequency during exacerbations) performed self-examinations using 3 devices: an artificial intelligence (AI)-aided home stethoscope (providing wheezes, rhonchi, and coarse and fine crackles intensity; respiratory and heart rate; and inspiration-to-expiration ratio), a peripheral capillary oxygen saturation (SpO2) meter, and a peak expiratory flow (PEF) meter and filled out a health state survey. The resulting 6,029 examinations were evaluated by physicians for the presence of exacerbations. For each registered parameter, a machine learning model was trained, and the area under the receiver operating characteristic curve (AUC) was calculated to assess its utility in exacerbation detection. RESULTS The best single-parameter discriminators of exacerbations were wheezes intensity for young children (AUC 84% [95% CI, 82%-85%]), rhonchi intensity for older children (AUC 81% [95% CI, 79%-84%]), and survey answers for adults (AUC 92% [95% CI, 89%-95%]). The greatest efficacy (in terms of AUC) was observed for a combination of several parameters. CONCLUSIONS The AI-aided home stethoscope provides reliable information on asthma exacerbations. The parameters provided are effective for children, especially those younger than 5 years of age. The introduction of this tool to the health care system might enhance asthma exacerbation detection substantially and make remote monitoring of patients easier.
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Affiliation(s)
- Andrzej Emeryk
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.)
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium (E.D.)
| | - Kamil Janeczek
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.);
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology, and Respiratory Oncology, Poznań University of Medical Sciences, Poznań, Poland (B.K.K.)
| | - Anna Zelent
- Department of Pediatric Pneumonology, Allergology, and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland (A.Z.)
| | - Mateusz Łukaszyk
- 1st Department of Lung Diseases and Tuberculosis, Faculty of Medicine, Medical University of Bialystok, Białystok, Poland (M.Ł.)
| | - Tomasz Grzywalski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Anna Pastusiak
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Adam Biniakowski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
| | | | - Dick Botteldooren
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Jędrzej Kociński
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Honorata Hafke-Dys
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
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Jones BL, Carter MC, Davis CM, Wang J. Diversity, Equity, and Inclusion: A Decade of Progress? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:116-125. [PMID: 36272720 DOI: 10.1016/j.jaip.2022.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
The concepts of diversity, equity, and inclusion are fundamental and more recently heavily discussed within medicine, research, and the larger society. There is increasing awareness that diversity of thoughts, perspectives, and backgrounds yields stronger teams and more effective results. There is also increasing awareness that stark inequities from systemic, institutional, and individual levels exist that limit the baseline opportunities for many populations. To close disparity gaps, broad aspects of diversity and promoting equity are required and efforts must be inclusive of those most marginalized. In this Clinical Commentary, we discuss, "How and If progress has been made in Diversity, Equity, Inclusion within the field of Allergy/Asthma/Immunology in the past decade?" We discuss the current state of clinical practice and what has been revealed over the past 10 years; describe our current workforce and what progress has or has not occurred there; and finally, review the state of scientific and medical research.
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Affiliation(s)
- Bridgette L Jones
- Department of Pediatrics, Section of Allergy, Asthma, Immunology and Division of Pediatric Clinical Pharmacology and Therapeutic Innovation, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, Kansas City, Mo.
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carla M Davis
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Julie Wang
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Shaker M, Mauger D, Fuhlbrigge AL. Value-Based, Cost-Effective Care: The Role of the Allergist-Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:132-139. [PMID: 35944893 DOI: 10.1016/j.jaip.2022.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Asthma and allergic disease impact millions of patients and are associated with high costs. Up to 30% of all medical care involves wasted spending. Across the spectrum of care provided by the allergist-immunologist, there are opportunities to improve value and reduce medical waste. Several examples highlight this reality. Evidence suggests that most patients may receive cost-effective care in the management of chronic spontaneous urticaria without the need for laboratory testing. For patients with asthma, although a single maintenance and reliever therapy approach may be cost-effective, insurance-mandated therapy changes are not, and may harm patients. Biologics may be very effective in improving asthma control but are too expensive for this indication-as demonstrated by cost-effectiveness analyses and highlighted by the Institute of Clinical and Economic Review, which concluded that the value-based price for asthma biologics ranges between $6500 and 14,3000 per year. Early introduction may prevent food allergy, but screening before first introduction is neither necessary nor cost-effective, although early salvage food oral immunotherapy may result in improved quality of life and cost savings. Evidence does not support the presence of allergic disease as a risk factor for anaphylaxis to coronavirus disease 2019 vaccination, and risk-stratified vaccination approaches do not appear cost-effective. Allergen immunotherapy is a very cost-effective treatment option. The practice of allergy-immunology has continued to evolve in recent years and can provide a leading example of high-value practice.
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Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - David Mauger
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, State College, Pa
| | - Anne L Fuhlbrigge
- Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
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