Intervention by a specially trained nurse can help asthma patients improve their quality of life and have fewer, shorter hospitalizations, according to a study by researchers at Washington University School of Medicine in St. Louis. The investigators also found that this type of intervention can save $4,600 per patient per year in health-care costs.
"An asthma nurse specialist who worked with at-risk patients during and after their hospitalizations made a big difference by providing social support and by ensuring they made it to follow-up doctorsí visits and stayed on their medications," said Mario Castro, M.D., assistant professor of medicine and the studyís principal investigator.
Nina Zimmerman, an asthma nurse specialist at Barnes-Jewish Hospital, which is part of the Washington University Medical Center, believes establishing a trusting relationship with the patients and offering them social support was key to the projectís success.
She presented the studyís findings May 7, 2000, at the American Thoracic Society International Meeting in Toronto, Canada. Washington University School of Medicine and Barnes-Jewish Hospital funded the Asthma Intervention Pilot Study.
Castro began the study in 1996 after noticing that asthma patients frequently return to the hospital or to the emergency department, often within a three-month period. "Some things werenít happening," Castro said. "We wanted to find out what those factors were and how we could effectively intervene."
To qualify for the randomized, controlled study, patients had to have been hospitalized or visited an emergency department for asthma in the previous year. On average, the 96 patients in the study had five emergency department visits and two hospitalizations prior to the beginning of the study. Eighty-five percent of them were African-American women in their mid-30s who, on average, had suffered from asthma for at least 15 years.
"We studied a very high-risk population," Castro said. "These were the toughest of the tough patients. But we feel that those kinds of patients give us the greatest opportunity to help."
In addition to battling severe asthma, many patients in the study did not have phones, health insurance or permanent homes, Castro and Zimmerman discovered.
Also decreases missed worked days
The researchers divided the patients into two groups. The 46 patients in the control group continued to receive standard care from their primary source of health-care. The 50 patients in the intervention group received ongoing asthma education about using their inhalers and peak-flow meters. The asthma nurse specialist also contacted them twice a month, either by phone or by visiting them at home, to offer support and to make sure they were taking their medications and going to scheduled doctorsí visits.
After 12 months, there were 42 hospitalizations in the control group but only 21 hospitalizations in the intervention group. "Asthma hospitalizations basically were cut in half in the group that received the intervention," said Castro. "And hospital stays related to asthma were cut from 129 days in the control group to 53 days in the intervention group."
The researchers also were surprised by the large decrease in missed work days in the intervention group. Patients in that group had a combined total of 120 missed work days because of asthma compared with 520 days in the control group. Both groups also scored significantly higher on a scale measuring quality of life.
Indirect and direct health-care costs were $450,000 in the control group and $220,000 in the intervention group, resulting in a savings of $230,000, or $4,600 per patient over a 12-month period.
The investigators believe this model of asthma health-care delivery can be used in a variety of health-care settings. "It would work in a health maintenance organization, an inner-city practice or a busy primary-care office that sees a lot of asthma patients," Castro said. "This simple intervention focusing on those most in need can result in improved asthma control and quality of life with a substantial cost saving."
By Diane Duke Williams