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Hatoun J, Barrieau DJ, Bryson EA, Bhaumik U, Woods ER. Primary care provider perceptions of an asthma home visiting program. J Asthma 2023; 60:1967-1972. [PMID: 37093899 DOI: 10.1080/02770903.2023.2206899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Pediatric asthma home visiting programs have improved clinical outcomes, but little is known about how providers perceive these programs. The purpose of this study was to understand how primary care providers and their colleagues in a medical home perceive an asthma home visiting program that is available at no cost to their patients. METHODS After several years of running an asthma home visiting program using community health workers (CHW) in 10 pediatric primary care offices in the South Coast of Massachusetts, we surveyed the providers of patients who had enrolled in the program. An anonymous online survey was developed by the program leaders, the program analytics team, and the CHWs for quality improvement purposes. Survey domains included the perceived utility of various aspects of the program, impact on patients, and interaction with CHWs, as well as demographic information about the providers. RESULTS Of the 24 providers asked to complete the survey from eight primary care practices, 21 completed the survey (88%). Respondents perceived that the most beneficial aspects were environmental assessment (95%), asthma education (91%), and addressing environmental issues (86%). In addition to numerous positive free-text responses, suggestions for improvement were in the areas of referral completion, post-visit communication, and patient identification in the medical record. All respondents would continue to refer to the program. CONCLUSIONS Primary care providers and medical home staff perceived an asthma home visiting program to have high utility, particularly the environmental assessment, asthma education, and mitigation of environmental issues. Additional opportunities for improvement were identified.
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Affiliation(s)
- Jonathan Hatoun
- Pediatric Physicians' Organization at Children's, Wellesley, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Daniel J Barrieau
- Pediatric Physicians' Organization at Children's, Wellesley, MA, USA
| | - Emily A Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Woods
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Padilla-Galo A, García-Ruiz AJ, Levy Abitbol RC, Olveira C, Rivas-Ruiz F, García-Agua Soler N, Pérez Morales M, Valencia Azcona B, Tortajada-Goitia B, Moya-Carmona I, Levy-Naon A. Real-life cost-effectiveness of benralizumab in patients with severe asthma. Respir Res 2021; 22:163. [PMID: 34044819 PMCID: PMC8155800 DOI: 10.1186/s12931-021-01758-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Availability of clinically effective and cost-effective treatments for severe asthma would be beneficial to patients and national healthcare systems. The aim of this study was to evaluate clinical outcomes and healthcare expenditure after incorporating benralizumab into the standard treatment of refractory eosinophilic asthma. METHODS This was a cross-sectional multicentre study of consecutive patients with refractory eosinophilic asthma who received treatment with benralizumab during at least 12 months. Patient follow-up was performed in specialised severe asthma units. The main effectiveness parameters measured were: the avoidance of one asthma exacerbation, a 3-point increase in the asthma control test (ACT) score, and the difference in utility scores (health-related quality of life) between a 1-year baseline treatment and 1-year benralizumab treatment. The health economic evaluation included direct costs and incremental cost-effectiveness ratios (ICERs). RESULTS After 1 year of treatment with benralizumab, patients with refractory eosinophilic asthma showed an improvement in all the effectiveness parameters analysed: improvement of asthma control and lung function, and decrease in the number of exacerbations, oral corticosteroid (both as corticosteroid courses and maintenance therapy), and inhaled corticosteroid use. The total annual cost per patient for the baseline and benralizumab treatment periods were €11,544 and €14,043, respectively, reflecting an increase in costs due to the price of the biological agent but a decrease in costs for the remaining parameters. The ICER was €602 per avoided exacerbation and €983.86 for every 3-point increase in the ACT score. CONCLUSIONS All the pharmacoeconomic parameters analysed show that treatment with benralizumab is a cost-effective option as an add-on therapy in patients with refractory eosinophilic asthma.
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Affiliation(s)
- A. Padilla-Galo
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - A. J. García-Ruiz
- Chair of Health Economics and Rational Use of Medicines, Department of Pharmacology and Clinical Therapeutics, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | | - C. Olveira
- Pneumology Department, IBIMA (Institute for Biomedical Research of Málaga), Regional University Hospital of Málaga, Avenida Carlos Haya, 29010 Málaga, Spain
- University of Málaga, Málaga, Spain
| | - F. Rivas-Ruiz
- Research Unit, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Spanish Healthcare Network for Chronic Diseases), Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - N. García-Agua Soler
- Chair of Health Economics and Rational Use of Medicines, Department of Pharmacology and Clinical Therapeutics, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - M. Pérez Morales
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - B. Valencia Azcona
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - B. Tortajada-Goitia
- Pharmacy and Nutrition Service, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - I. Moya-Carmona
- Pharmacy and Nutrition Service, Hospital Universitario Virgen de La Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
| | - A. Levy-Naon
- Pneumology Department, Hospital Universitario Virgen de La Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
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Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134846. [PMID: 32640508 PMCID: PMC7370127 DOI: 10.3390/ijerph17134846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022]
Abstract
Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children’s hospital and the air pollution data, including particulate matter 2.5 (PM2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008–1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001–1.045, p = 0.042) and PM2.5 concentrations (OR = 1.080, 95% CI = 1.005–1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.
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Padilla-Galo A, Levy-Abitbol RC, Olveira C, Valencia Azcona B, Pérez Morales M, Rivas-Ruiz F, Tortajada-Goitia B, Moya-Carmona I, Levy-Naon A. Real-life experience with benralizumab during 6 months. BMC Pulm Med 2020; 20:184. [PMID: 32600318 PMCID: PMC7325276 DOI: 10.1186/s12890-020-01220-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/18/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Benralizumab is a monoclonal antibody that binds to the human interleukin-5 (IL-5) receptor (IL-5R), thereby preventing IL-5 from binding to its receptor and inhibiting differentiation and maturation of eosinophils in the bone marrow. Because of its recent marketing approval, sufficient real-life evidence is lacking to confirm the efficacy and safety data from clinical trials. The purpose of this study was to evaluate the efficacy and safety of benralizumab for the treatment of severe refractory eosinophilic asthma in a real-world cohort of patients. METHODS This was a cross-sectional multicentre study of consecutive patients with severe refractory eosinophilic asthma who received treatment with benralizumab during at least 6 months. Patient follow-up was performed in specialised severe asthma units. RESULTS A total of 42 patients were enrolled and treated with benralizumab. Asthma control, as measured by the asthma control test (ACT), improved in all patients both at 3 months of treatment compared with baseline (13.9 ± 4 vs 20.1 ± 3.7, p < 0.001) and at 6 months of treatment compared with the results obtained at 3 months (20.1 ± 3.7 vs 21 ± 2.7, p = 0.037). Similarly, the number of emergency department visits decreased both at 3 months compared with baseline (1 [IR:0.7] vs 0 [IR:0.75], p < 0.001) and at 6 months compared with the results at 3 months (0 [IR:0.75] vs 0 [IR:0], p = 0.012). Reductions in the number of oral corticosteroid cycles, percentage of corticosteroid-dependent patients, and mean daily dose of oral or inhaled corticosteroid were also evidenced. Finally, mean lung function improvement was 291 mL (p < 0.001), and FEV1% improved both at 3 months compared with baseline (64.4 ± 9.3 vs 73.1 ± 9.1, p < 0.001) and at 6 months compared to 3 months (73.1 ± 9.1 vs 76.1 ± 12, p = 0.002). Side effects were mild and did not lead to treatment discontinuation. CONCLUSIONS This study confirms the efficacy and safety of benralizumab in a real-life setting with improved asthma control and lung function, and a reduced oral and inhaled corticosteroid use as well as fewer emergency department visits. In addition to a rapid initial improvement, it appears that patients continue to improve during the first 6 months of treatment.
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Affiliation(s)
- A. Padilla-Galo
- Pneumology Unit, 4th floor. Agencia Sanitaria Costa del Sol. Carretera Nacional 340, Km 187, 29603, Marbella, Málaga, Spain
| | | | - C. Olveira
- Pneumology Department, IBIMA (Institute for Biomedical Research of Málaga), Regional University Hospital of Málaga/ University of Málaga, Málaga, Spain
- Avenida Carlos Haya, 29010 Málaga, Spain
| | - B. Valencia Azcona
- Pneumology Unit, 4th floor. Agencia Sanitaria Costa del Sol. Carretera Nacional 340, Km 187, 29603, Marbella, Málaga, Spain
| | - M. Pérez Morales
- Pneumology Unit, 4th floor. Agencia Sanitaria Costa del Sol. Carretera Nacional 340, Km 187, 29603, Marbella, Málaga, Spain
| | - F. Rivas-Ruiz
- Research Unit, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Spanish healthcare network for chronic diseases), Agencia Sanitaria Costa del Sol. Carretera Nacional 340, Km 187, 29603, Marbella, Málaga, Spain
| | - B. Tortajada-Goitia
- Pharmacy and Nutrition Service, Agencia Sanitaria Costa del Sol. Carretera Nacional 340, Km 187, 29603 Marbella, Málaga Spain
| | - I. Moya-Carmona
- Pharmacy and Nutrition Service, Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
| | - A. Levy-Naon
- Pneumology Department, Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
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Baek J, Huang K, Conner L, Tapangan N, Xu X, Carrillo G. Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study. BMC Public Health 2019; 19:912. [PMID: 31288792 PMCID: PMC6617892 DOI: 10.1186/s12889-019-7272-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.
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Affiliation(s)
- Juha Baek
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA
| | - Ke Huang
- Department of Statistics, Texas A&M University, Blocker Building, 3143, 155 Ireland St, College Station, TX, 77843, USA
| | - Lucia Conner
- Program on Asthma Research and Education, Healthy South Texas, Texas A&M School of Public Health, McAllen Campus, 2101 S. McColl Road, McAllen, TX, 78503, USA
| | - Niko Tapangan
- Hidalgo County Health and Human Services Department, 1304 S 25th Ave, Edinburg, TX, 78542, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA.
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