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Cited by 41Asthma and respiratory diseasesHealth Literacy and Information AccessibilityOccupational exposure and asthma

Home visits for uncontrolled asthma among low-income adults with patient portal access

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Apter, Andrea J., Localio, A. Russell, Morales, Knashawn H., Han, Xiaoyan, Perez, Luzmercy, Mullen, Alyssa N., Rogers, Marisa, Klusaritz, Heather +3 more·2019·Journal of Allergy and Clinical Immunology
DOI 10.1016/j.jaci.2019.05.030PMC PMC6742549
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Abstract

Background Asthma disproportionately affects low-income and minority adults. In an era of electronic records and Internet-based digital devices, it is unknown whether portals for patient-provider communication can improve asthma outcomes.Objective We sought to estimate the effect on asthma outcomes of an intervention using home visits (HVs) by community health workers (CHWs) plus training in patient portals compared with usual care and portal training only.Methods Three hundred one predominantly African American and Hispanic/Latino adults with uncontrolled asthma were recruited from primary care and asthma specialty practices serving low-income urban neighborhoods, directed to Internet access, and given portal training. Half were randomized to HVs over 6 months by CHWs to facilitate competency in portal use and promote care coordination.Results One hundred seventy (56%) patients used the portal independently. Rates of portal activity did not differ between randomized groups. Asthma control and asthma-related quality of life improved in both groups over 1 year. Differences in improvements over time were greater for the HV group for all outcomes but reached conventional levels of statistical significance only for the yearly hospitalization rate (-0.53; 95% CI, -1.08 to -0.024). Poor neighborhoods and living conditions plus limited Internet access were barriers for patients to complete the protocol and for CHWs to make HVs.Conclusion For low-income adults with uncontrolled asthma, portal access and CHWs produced small incremental benefits. HVs with emphasis on self-management education might be necessary to facilitate patient-clinician communication and to improve asthma outcomes.

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Authors
Apter, A. J., Localio, A. R., Morales, K. H., Han, X., Perez, L., Mullen, A. N., Rogers, M., Klusaritz, H., Howell, J. T., Canales, M. N., & Bryant-Stephens, T.
Affiliations
  • University of Pennsylvania Health System (US)
  • University of Pennsylvania (US)
  • Temple University Health System (US)
  • Children's Hospital of Philadelphia (US)
Corresponding author
Apter, Andrea J.
ORCID
Venue
Journal of Allergy and Clinical Immunology
Publisher
Elsevier BV
Published
2019-09
Volume
144
Issue
3
Pages
846-853.e11
ISSN
0091-6749 (ISSN-L)
DOI
10.1016/j.jaci.2019.05.030
PMC
PMC6742549
OpenAlex
W2950766885
Cited by
41
References
58
Citations by year
2026: 4 · 2025: 2 · 2024: 7 · 2023: 5 · 2022: 10 · 2021: 8 · 2020: 3 · 2019: 1
FWCI
3.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Allergy and Clinical Immunology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (R18 HL116285)
  • National Heart, Lung, and Blood Institute
  • Patient-Centered Outcomes Research Institute (AS 1307-05218)
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Keywords
uncontrolled asthma, home visits, community health workers, patient portals, low-income adults, African American adults, Hispanic adults, asthma control, asthma quality of life, hospitalization, care coordination, self-management education, internet access, neighborhood disadvantage, patient-provider communication
MeSH terms
Patient Portals, Adolescent, Adult, Aged, Aged, 80 and over, Asthma, Community Health Workers, Female, Health Education, House Calls, Humans, Male, Middle Aged, Poverty, Quality of Life, Young Adult

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