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Baptist AP, Apter AJ, Gergen PJ, Jones BL. Reducing Health Disparities in Asthma: How Can Progress Be Made. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:737-745. [PMID: 36693539 PMCID: PMC10640900 DOI: 10.1016/j.jaip.2022.12.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Health disparities (recently defined as a health difference closely linked with social, economic, and/or environmental disadvantage) in asthma continue despite the presence of safe and effective treatment. For example, in the United States, Black individuals have a hospitalization rate that is 6× higher than that for White individuals, and an asthma mortality rate nearly 3× higher. This article will discuss the current state of health disparities in asthma in the United States. Factors involved in the creation of these disparities (including unconscious bias and structural racism) will be examined. The types of asthma interventions (including case workers, technological advances, mobile asthma clinics, and environmental remediation) that have and have not been successful to decrease disparities will be reviewed. Finally, current resources and future actions are summarized in a table and in text, providing information that the allergist can use to make an impact on asthma health disparities in 2023.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Bridgette L Jones
- Section of Allergy Asthma Immunology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Mo; Children's Mercy, Kansas City, Mo
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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Orsak G, Starnes K, Ledlow G. Examining the Return on Investment of the Breath of Life Mobile Pediatric Asthma Clinic in a Rural Region with Small Metropolitan Statistical Areas. Hosp Top 2018; 96:95-101. [PMID: 30277451 DOI: 10.1080/00185868.2018.1488546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The current study sought to examine the return on investment (ROI) of a mobile pediatric asthma clinic in a rural region with small metropolitan statistical areas, in terms of reduced costs attributed to preventable emergency department visits, inpatient admission, school absenteeism, cost of education, and parent work absenteeism. For fiscal years 2015 and 2016, an average return of $1.32 and a community ROI of $1.45 was estimated. Estimated benefits were $445,125.00 and cost avoidance was $263,853.01. A mobile pediatric asthma clinics operating in less densely populated regions is able to yield a positive ROI.
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Affiliation(s)
- Gabriela Orsak
- a Department of Epidemiology and Biostatistics , University of Texas Health Science Center at Tyler , Tyler , Texas , USA
| | - Kate Starnes
- b Department of Healthcare Policy, Economics and Management , University of Texas Health Science Center at Tyler , Tyler , Texas , USA
| | - Gerald Ledlow
- b Department of Healthcare Policy, Economics and Management , University of Texas Health Science Center at Tyler , Tyler , Texas , USA
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Louisias M, Phipatanakul W. Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap. Curr Allergy Asthma Rep 2017; 17:68. [PMID: 28914405 DOI: 10.1007/s11882-017-0734-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. RECENT FINDINGS Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
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Affiliation(s)
- Margee Louisias
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Gaglioti AH, Barlow P, Thoma KD, Bergus GR. Integrated care coordination by an interprofessional team reduces emergency department visits and hospitalisations at an academic health centre. J Interprof Care 2017; 31:557-565. [PMID: 28726526 DOI: 10.1080/13561820.2017.1329716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group. We implemented an integrated, interprofessional care management programme for adults with chronic mental and physical health needs as part of a curriculum for family medicine and family medicine psychiatry residents. We then evaluated the clinical effectiveness of this programme by describing participants' healthcare utilisation patterns pre- and post-enrolment. Patients enrolled in the programme were approximately 60-70% less likely to utilise the emergency room and 50% less likely to be admitted to the hospital after enrolment in the programme compared to before enrolment. The odds of individual attendance at outpatient primary care and mental health visits improved after enrolment. In the context of the implementation of integrated behavioural and physical healthcare in primary care, this interprofessional care management programme reduced emergency department utilisation and hospitalisations while improving utilisation of primary care and psychiatry outpatient care. Further studies should focus on replication of this model to further discern the model's cost-savings and health promotion effects.
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Affiliation(s)
- Anne H Gaglioti
- a Department of Family Medicine, National Center for Primary Care , Morehouse School of Medicine , Atlanta , Georgia , USA
| | - Patrick Barlow
- b General Internal Medicine, Department of Internal Medicine , University of Iowa Carver College of Medicine , Iowa City , Iowa , USA
| | - Kate DuChene Thoma
- c Department of Family Medicine , University of Iowa Carver College of Medicine , Iowa City , Iowa , USA
| | - George R Bergus
- c Department of Family Medicine , University of Iowa Carver College of Medicine , Iowa City , Iowa , USA
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