Community Health Worker Home Visits for Adults With Uncontrolled Asthma—The Homebase Trial Randomized Clinical Trial

The Journal of Emergency Medicine contracting communicable diseases. The authors for this study noted that little is known about the thoughts and feelings of bystanders after being involved in an out-of-hospital resuscitation. This qualitative study explored the concept of systematic debriefing of bystanders after participating in OHCA resuscitation. Twelve medical dispatchers were recruited from the Emergency Medical Dispatch Centre in the Capital Region of Denmark to provide telephone debriefing to bystanders during the study period from March to July 2013. All 33 bystanders who participated in OHCA agreed to participate in the telephone debriefing sessions. A standard debriefing guideline was formulated and used to interview each bystander. All bystanders received debriefing calls from medical dispatchers 2 to 4 days after a resuscitation attempt. A group of 15 bystanders was invited to participate in a follow-up research study using a different standard interview guide 1 to 2 months after the OHCA to evaluate their perception of the concept of debriefing. All interviews were audiorecorded and analyzed using a phenomenologic approach. Six main themes were addressed by bystanders: 1) difficulty in identifying an OHCA; 2) perceived differences between an actual OHCA scenario and those portrayed in basic life-support courses; 3) challenges and successes in collaborating with trained medical professionals; 4) identification of patient outcomes as a surrogate marker for bystanders’ performances; 5) coping mechanisms; and 6) general reflections. Short-term benefits of debriefing identified by bystanders included provision of psychological support by professionals in cases of psychological reactions, feelings of emotional relief, and the opportunity to discuss the resuscitation in a technical manner with a health-care professional. Bystanders continued to reflect on their experiences at the 2-month follow-up and all reported that they viewed the opportunity to discuss the resuscitation as the most beneficial aspect of the debriefing call. [Christa Brink Kahn, MD Denver Health Medical Center, Denver, CO] Comment: Debriefing is an important step in closing a resuscitation encounter, whether this occurs in the inpatient setting, emergency department, or prehospital environment. All levels of providers express doubts and feel anxiety over certain resuscitative efforts. The opportunity to discuss challenging cases aids in the professional development of trained providers. Similarly, debriefing of bystanders creates a unique window in which to support members of our communities in their efforts to provide early emergency care, including CPR for OHCA. , COMMUNITY HEALTH WORKER HOME VISITS FOR ADULTS WITH UNCONTROLLED ASTHMA—THE HOMEBASE TRIAL RANDOMIZED CLINICAL TRIAL. Krieger J, Song L, Philby M. JAMA Intern Med 2015;175:109 17. The effectiveness of self-management of asthma depends largely on the extent to which a person has learned such skills. Studies have established the success of home-based self-management support for improving asthma control in children.

525 This randomized parallel-group controlled study investigated the Home-Based Asthma Support and Education (HomeBASE) trial, and hypothesized that community health workers (CHWs) could reduce morbidity among adults with uncontrolled asthma by providing in-home self-management support. A total of 366 low-income adults ages 18 to 65 years with uncontrolled or poorly controlled asthma (defined as either > 4 days of symptoms, > 1 nighttime awakening, > 4 days of a short-acting b-agonist, or interference of normal activities due to asthma symptoms in the past 2 weeks, or $ 1 emergency department visits for asthma) living in King County, Washington were randomized to a group receiving the CHW intervention (n = 177) or to the control group (n = 189). Primary outcomes were numbers of self-reported asthma symptom-free days; Mini Asthma Quality of Life Questionnaire scores, with a higher score indicating better quality of life; and numbers of self-reported asthma-related urgent health-care visits in the preceding 12 months. The intervention group had significantly greater increases in symptom-free days per 2-week period (2.02; 95% confidence interval [CI] 0.94 3.09; p < 0.001) and quality of life scores (0.50; 95% CI 0.28 0.70; p < 0.001) when compared to the control group and adjusted for age, sex, race/ethnicity, and education level. The number needed to treat to increase symptomfree days by 2 days in 2 weeks was 7.4. Both the control and intervention groups had similar decreases in the number of unscheduled urgent/emergent visits; the CHW group demonstrated 1.47 fewer episodes (95% CI 2.28 to 0.67; p < 0.001) vs. the control group, which demonstrated 1.34 fewer episodes (95% CI 2.00 to 0.72; p < 0.001). Secondary outcomes, including number of asthma exacerbations, pulmonary function, asthma-control level, effect on productivity, and overall health status, generally also improved in the intervention group. The intervention group consistently demonstrated improved patient-centered outcomes, including quality of life, frequency of symptoms, and general well-being, suggesting that homebased asthma education and intervention are effective tools for adults to decrease the morbidity associated with poorly controlled asthma. [Christa Brink Kahn, MD Denver Health Medical Center, Denver, CO] Comment: Of the 24.6 million Americans with asthma, 17.5 million are adults. An estimated 72% of patients included in the study had poorly controlled asthma. The trial delineated clinically meaningful effects of in-home asthma education and support. More information is needed, however, to establish whether this is a cost-effective approach to management of poorly controlled asthma. , TRENDS IN OPIOID ANALGESIC ABUSE AND MORTALITY IN THE UNITED STATES. Dart RC, Surratt HL, Cicero TJ, et al. N Engl J Med 2015;372:241 8. In the United States, an estimated 25 million people initiated nonmedical use of prescription opioid medications between