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J Gen Intern Med. 2012 Aug;27(8):1001-15. doi: 10.1007/s11606-012-2058-9.

Interventions to improve outcomes for minority adults with asthma: a systematic review.

Author information

1
Section of Hospital Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 5000, W305, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu

Abstract

OBJECTIVES:

To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma.

DATA SOURCES:

Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations.

INCLUSION CRITERIA:

adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS: Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes.

RESULTS:

Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n = 14), followed by Latino/a (n = 4), Asian Americans (n = 1), or a combination of the above (n = 5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results.

LIMITATIONS:

Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:

Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. System-redesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.

PMID:
22798212
PMCID:
PMC3403146
DOI:
10.1007/s11606-012-2058-9
[Indexed for MEDLINE]
Free PMC Article

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