Interventions to improve outcomes for minority adults with asthma: a systematic review.
OBJECTIVE
To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma.


METHODS
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.


METHODS
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.


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


CONCLUSIONS
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.
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
Valerie G
VG
Press
Andrea A
AA
Pappalardo
Walter D
WD
Conwell
Amber T
AT
Pincavage
Meryl H
MH
Prochaska
Vineet M
VM
Arora
D001249:Asthma / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D006801:Humans; D008913:Minority Groups; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000639:trends; D016896:Treatment Outcome