Puerto Rican children have the highest rates of asthma morbidity of any etnic group and are more likely todie because of their asthma as compared with other children. In Puerto Rico gross disparities exist in thequality of asthma care received by poor asthmatic children compared to higher income children. Asdescribed by the Institute of Medicine, such health disparities likely result from multi-level barriers toappropriate care. Based on a conceptual model of health disparities developed by this investigative group,we propose to evaluate the effectiveness of the Pediatric Asthma Community- Based Program (PACBP), anovel, multi-level intervention designed to eliminate asthma disparities in treatment by intervening at thehealth policy, provider, and family level.
Aim 1 will use a non-experimental pre-post comparison design toassess a historic change in medication policy (i.e., the state assuming responsibility for the cost ofmedication) in a pilot health region in Puerto Rico. We will use automated claims and pharmacy data oneyear prior to and one-and-a-half years post policy change to compare pharmacy dispensing of antiinflammatorycontroller medications (ACMs), oral steroids and beta agonists (primary outcome), as well asrates of Emergency Department (ED) visits and hospital admissions (secondary outcomes) in children withpersistent asthma.To examine the impact of change at the provider level, Aim 2 will use a randomizedcontrol trial (RCT) design nested within the pilot region to study the impact of a culturally-adapted version ofthe Easy Breather Program ( EBP), a provider-focused educational intervention designed to increaseguideline-based care. Using claims data, we will compare rates of ACM dispensing (primary outcome), aswell as beta-agonist and oral steroid dispensing. We will also compare chart audits of guideline-based care,and provider surveys of asthma management practices. To examine the impact of change at the familylevel, Aim 3 will use a RCT to test a family-based asthma management intervention (FAMI), nested in clinicsof the Pilot region that received the EBP. This intervention is designed to increase family knowledge, skillsand self-efficacy for asthma management. The primary outcome variable for the FAMI study is symptomfreedays. Secondary outcomes include ACM use and quality of life, as well ED visits and hospitaladmissions, beta agonist and oral steroids use, and functional disability. Finally, Aim 4 will evaluate the costeffectivenessof each level of the Pediatric Asthma Community-Based Program (PACBP). The proposedstudy will be the first to test a culturally-adapted, community-based intervention that addresses theelimination of health disparities by intervening at the provider, family and health policy level.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Comprehensive Center (P60)
Project #
1P60MD002261-01
Application #
7314592
Study Section
Special Emphasis Panel (ZMD1-MR (08))
Project Start
2007-07-01
Project End
2012-05-31
Budget Start
2007-07-01
Budget End
2008-05-31
Support Year
1
Fiscal Year
2007
Total Cost
$654,647
Indirect Cost
Name
University of Puerto Rico Med Sciences
Department
Type
DUNS #
948108063
City
San Juan
State
PR
Country
United States
Zip Code
00936
Allen, Michele L; Cook, Benjamin Lê; Carson, Nicholas et al. (2017) Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics. Adm Policy Ment Health 44:431-440
Carson, Nicholas J; Katz, Arlene M; Alegría, Margarita (2016) How patients and clinicians make meaning of physical suffering in mental health evaluations. Transcult Psychiatry 53:595-611
Alcántara, Carmela; Li, Xinliang; Wang, Ye et al. (2016) Treatment moderators and effectiveness of Engagement and Counseling for Latinos intervention on worry reduction in a low-income primary care sample. J Consult Clin Psychol 84:1016-1022
Alegría, Margarita; Alvarez, Kiara; Ishikawa, Rachel Zack et al. (2016) Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 35:991-9
Canino, Glorisa; Shrout, Patrick E; Vila, Doryliz et al. (2016) Effectiveness of a multi-level asthma intervention in increasing controller medication use: a randomized control trial. J Asthma 53:301-10
Hahm, Hyeouk Chris; Cook, Benjamin Lê; Ault-Brutus, Andrea et al. (2015) Intersection of race-ethnicity and gender in depression care: screening, access, and minimally adequate treatment. Psychiatr Serv 66:258-64
Alcántara, Carmela; Chen, Chih-Nan; Alegría, Margarita (2015) Transnational ties and past-year major depressive episodes among Latino immigrants. Cultur Divers Ethnic Minor Psychol 21:486-95
Alcántara, Carmela; Chen, Chih-Nan; Alegría, Margarita (2014) Do post-migration perceptions of social mobility matter for Latino immigrant health? Soc Sci Med 101:94-106
Stein, Gabriela L; Lee, Catherine S N; Shi, Ping et al. (2014) Characteristics of community mental health clinics associated with treatment engagement. Psychiatr Serv 65:1020-5
Alegría, Margarita; Carson, Nicholas; Flores, Michael et al. (2014) Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention. JAMA Psychiatry 71:557-65

Showing the most recent 10 out of 88 publications