Asthma and COPD are manageable lung conditions, but patients who face barriers to recommended care can experience worsening symptoms that lead to emergency department visits and hospitalizations.
A new study by researchers at UC San Francisco shows that pairing vulnerable, low-income patients with health coaches can improve outcomes and may also reduce costs associated with avoidable health care use. The study, published in the Annals of the American Thoracic Society on May 18, was supported by the National Institutes of Health (NIH).
In the study, researchers led by co-principal investigators Rachel Willard-Grace, MPH, director of the UCSF Center for Excellence in Primary Care, and George Su, MD, a professor at the UCSF School of Medicine, divided about 330 patients at 10 urban health clinics into two groups. One group continued their usual care with their primary care team; the other participated in a 16-week intervention with a coach — a trained, unlicensed health worker who liaised between the patient and a pulmonary specialist nurse practitioner. Recommendations were made to the patient’s primary care doctor based on identified gaps in care.
The study patients were all publicly insured and reported poor control of symptoms. Two in 3 had asthma, and the majority of these had mild or moderate illness. The remainder had COPD (chronic obstructive pulmonary disease) or both diagnoses. One in 4 needed help reading medical information, 1 in 4 had diabetes, and 1 in 3 had substance use disorder.
Coaches helped patients manage shortness of breath by reducing triggers or using breathing techniques, ensured correct inhaler use, reminded them about appointments and medication pick-ups, and helped them recognize the symptoms that signal a flare-up.
Models like this can accelerate the adoption of new guidelines and provide much needed support for primary care providers.
Rachel Willard-Grace, MPH
Model may help fill gaps in primary care
Researchers found that patients in the intervention group received about 60% more recommended care than those receiving usual care, and that 86% of recommendations made to the primary care doctor were followed.
Among the improvements, 69% of intervention patients with asthma started an inhaler to reduce inflammation, compared with 12% in the usual care group. Previously, this medication was recommended for moderate-to-severe asthma, but newer studies show it should be extended to mild asthma.
“Primary care doctors are managing a broad range of conditions and rapidly evolving evidence and may not have time to keep up with every new study,” said Willard-Grace. “Models like this can accelerate the adoption of new guidelines and provide much needed support for primary care providers.”
Other benefits included increases in patients undergoing a pulmonary function test to assess breathing, more patients with allergies placed on anti-allergy medications, and more patients with COPD receiving long-acting agents to maintain lung function and reduce symptoms.
At the end of the study, patients in the intervention reported significantly improved breathing and milder symptoms, and better quality of care.
Although the focus of the study was not on saving health care costs, the program could reduce expensive emergency department visits, according to Su, who is also a pulmonologist at Zuckerberg San Francisco General Hospital.
“Even patients with mild asthma can experience severe flare-ups if barriers are not addressed,” Su noted. “A patient may need a controller inhaler but be too busy managing other demands to pick up a prescription. Poorly controlled asthma followed by a simple cold can progress to a flare-up and an emergency department visit. A coach, meanwhile, may help patients stay engaged with treatment and get back on track.”
Co-Authors: Please see the paper.
Funding: National Heart, Lung, and Blood Institute (NHLBI 1R01HL143366-01A1), NIH/NCRR Colorado-CTSI (UL1 RR025780), UCSF-CTSI (UL1 TR001872).