Mount Sinai was part of the largest clinical trial for asthma self-management support in older patients, which resulted in improved control and quality of life, and fewer emergency department visits.
Topic: Asthma affects 7 percent of Americans older than 65 and causes more symptoms and hospitalizations in this age group than in younger patients with asthma. While experts have called for interventions specifically targeting this population, few relevant studies have been reported. Mount Sinai and other institutions tested the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes.
What: This is the largest study ever conducted for an intervention to improve outcomes in older adults with asthma. It is also the first study to screen patients for barriers to control of their asthma, including social determinants of health, and target only the identified barriers for intervention. The intervention resulted in improved asthma control and quality of life, and led to fewer emergency department visits. Additionally, very few studies involve systematic evaluation of social determinants of health with actions linked to the data that are collected.
Corresponding Author: Alex D. Federman, MD, MPH, Professor of Medicine (General Internal Medicine), Icahn School of Medicine at Mount Sinai
Results: In this randomized trial that included 391 adults, intervention patients had significantly better asthma control, quality of life, medication adherence, and inhaler technique than control patients. The proportion of intervention patients with an emergency department visit for asthma was 6 percent vs. 12 percent, a significant difference.
Why the Research Is Interesting: Older adults receiving a patient-tailored self-management support intervention for asthma, whether in the home or clinic, achieved meaningful improvements in asthma control and quality of life, self-management behaviors, and reductions in ED visits compared to patients in usual care. By specifically targeting social determinants of health and other drivers of health-related behaviors, the intervention is a promising model of self-management support and disease control for older adults with asthma, and possibly other chronic diseases.
Who: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York; Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago; Department of Psychology, The Graduate Center, City University of New York; City Health Works, New York; Institute for Family Medicine, New York; Little Sisters of the Assumption Family Health Service, New York; Department of Psychology, Hunter College, City of New York.
When: Three-arm randomized clinical trial conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City.
Paper Title: 'Effect of a self-management support intervention on asthma outcomes in older adults: The SAMBA Study randomized clinical trial.'
Said Mount Sinai's Dr. Federman of the research:
"Health systems, insurers, and policymakers are increasingly recognizing the powerful influence of social factors on health and outcomes of health like hospitalizations and health care spending. Despite gaining more attention, few studies have tested ways of providing health care that address these social determinants of health. This newly developed approach is helping people with complex health problems, in this case older adults with asthma. By screening patients for barriers to controlling their asthma and addressing the barriers that were identified, the new program helped these older adults take their medications regularly, improve their control of asthma, and reduce their visits to emergency departments by more than 50 percent."
Funding: Funding was provided by the Patient-Centered Outcomes Research Institute (grant No. 1307-05585).
To request a copy of the paper or to schedule an interview with Dr. Alex Federman, please contact Mount Sinai's Director of Media and Public Affairs, Renatt Brodsky, at Renatt.Brodsky@mountsinai.org or at 212 241-9200.