Patient Advocates for low-income adults with moderate-severe asthma: a randomized clinical trial

ABSTRACT Background Few interventions have targeted low-income adults with moderate-severe asthma despite their high mortality. Objective To assess whether a Patient Advocate intervention improves asthma outcomes over usual care. Methods This 2-armed randomized clinical trial recruited adults with moderate-severe asthma from primary care and asthma specialty practices serving low-income neighborhoods. Patients were randomized to 6 months of a Patient Advocate Intervention or usual care. Patient Advocates were recent college graduates anticipating healthcare careers, who coached, modeled, and assisted participants with preparations for asthma-related medical visits; attended visits; and confirmed participants' understanding of provider recommendations. Participants were followed for at least a year for patient-centered asthma outcomes: asthma control (primary outcome), quality of life, prednisone requirements, emergency department visits, hospitalizations. Results Of 312 participants, mean age: 51(range:19-93), 69% female, 66% African American, 8% Hispanic/Latino; 62% reported hospitalization for asthma in the year before randomization. 21% had diabetes, 61% BMI > 30. Asthma control improved over 12 months, more in the intervention group [-0.45(-0.67, -0.21)] than in usual care [-0.26(-0.53, -0.01)], was sustained at 24 months but with no statistical difference between groups. The 6-month rate of ED visits decreased in intervention: -0.90(-1.56, -0.42) and usual care over 12 months: -0.42(-0.72, -0.06) groups. The cost of the Patient Advocate program was $1,521 per patient. Only 64% of those assigned had a Patient Advocate visit. Conclusions A Patient Advocate may be a promising intervention to improve and sustain outcomes in this high-risk population if expanded to address factors that make keeping appointments difficult.