Allergy and Airway: Asthma |

A Single Home Visit Improves Patient Adherence and Reduces Exacerbations in Patients With Severe Asthma and COPD FREE TO VIEW

D Richard Allison, NP; Karl Van Gundy; Jose Vempilly; Vipul Jain, MD
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UCSF Fresno, Fresno, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):15A. doi:10.1016/j.chest.2016.08.018
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the impact of a single Home Visit (HV) on patient adherence and emergency room (ER) visits in frequent exacerbators of Severe Asthma and COPD

METHODS: We used a retrospective cohort study design in patients with Severe Asthma and COPD with frequent exacerbations (2 or more ER visits or hospitalizations in the year prior to enrollment) enrolled in an Integrated Disease Management (IDM) Program. A single HV was performed for patients with established noncompliance to office visits (defined as 3 or more “no-show” to office visits), as well as compliant patients with uncontrolled symptomatology to address triggers in home environment. Healthcare utilization and patient adherence (compliance with inhalers and office visits) was assessed in the year prior to and after the HV.

RESULTS: A total of 60 patients had HV, of which 46 (77%) had noncompliance to office visits. Contact was made with 24 (52%) patients during the HV and these were subject to analyses. Mean age was 55 ± 14 years and 63% were women. Average FEV1 was 1.55L (51% predicted). 14 (58%) were active smokers and 18 (75%) had a history of drug use. There was a significant increase in compliance with office visits in the year following the HV as compared to the year before HV (68 vs 133 visits post-HV). Similarly there was a significant reduction in the ER visits post-HV (52 visits vs 31 visits post-HV), and this was associated with a significant improvement in patient adherence to maintenance inhaler use (22% versus 65% adherence, p<0.001). There was no significant change in hospital admissions post-HV.

CONCLUSIONS: In frequent exacerbators of asthma and COPD with established noncompliance to office visits, a single HV may significantly improves patient adherence to office visits and inhaler use, and may reduce severe exacerbations requiring ER visits. This may possibly be mediated via establishment of provider-patient trust and psychosocial well-being.

CLINICAL IMPLICATIONS: A single HV improves healthcare utilization and adherence in frequent exacerbators of asthma and COPD with established noncompliance, and should be considered in an IDM program.

DISCLOSURE: The following authors have nothing to disclose: D Richard Allison, Karl Van Gundy, Jose Vempilly, Vipul Jain

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