A single home visit improves adherence and reduces healthcare utilization in patients with frequent exacerbations of Severe Asthma and COPD

Background

Nonadherence to treatment recommendation, common in patients with COPD and Asthma, leads to poor disease control, frequent exacerbations and emergency room visits. We studied the effect of a single home visit (HV) on adherence and health care utilization in a cohort of non-compliant Asthma and COPD patients.

Methods

Patients with severe Asthma and COPD with frequent exacerbations deemed non-compliant were subjected to a single home visit by a multidisciplinary team. Adherence to inhalers and office visits, and healthcare utilization were assessed a year prior to and after the home visit.

Results

A total of 60 patients had an attempted home visit. Contact was made with 36 patients during the home visits and these were subject to analyses. Mean age was 60, and 61% were women. Average FEV1 was 1.56 L (55% predicted). There was a significant increase in compliance with office visits in the year following the HV as compared to the year before HV (87 vs 145 visits post-HV). Similarly, there was a significant reduction in the ER visits (76 visits vs 34 visits post-HV), and hospital admission (39 visits vs 24 post HV) and this was associated with a significant improvement in patient adherence to maintenance inhaler use - 17% (6 of 36) vs 53% (19 of 36).

Conclusion

In patients with frequent exacerbations of Asthma and COPD with confirmed non-compliance, a single home visit by a multidisciplinary team improved patient adherence to inhalers and office visits and reduced healthcare utilization.