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Tuesday, December 20, 2016

Home visits are needed to address asthma health disparities in adults

Asthma is a huge public health problem in the United States today.  But all asthmatics are not affected equally – there are a lot of disparities in asthma care.  In this month’s issue of the Journal of Allergy and Clinical Immunology, Bryant-Stephens and colleagues describe the need for home visits to address these asthma health disparities (J Allergy Clin Immunol 2016; 138(6): 1526-1530).  They note that most of the research on asthma so far has been on patients who go to clinics.  This has meant that people who have problems getting to the clinic, like the elderly, disabled, and those with other chronic conditions are often left out.  To help prevent overlooking these blindspots, they advocate for the involvement of community health workers.  In particular, they describe the experiences of three community health workers when they visited patients.  They found that the challenges at home are often overwhelming.  Social stressors in patients’ lives can be major problems interfering with their ability to take care of their asthma and other health problems. Community health workers may be used to provide resources to overcome these barriers and to encourage patients to adopt healthier habits, such as smoking reduction, and better communication with providers.   Even though home visits are not routine in clinical practice and are only rarely used in research settings, Bryant and colleagues suggest that there may be greater room for community health workers.  They recommend examination of the costs as well as benefits, and identifying vulnerable patients who would be best managed in this way.  They conclude that there needs to be better understanding of the barriers to optimal asthma management, so that these disparities can be addressed directly.

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