Asthma morbidity is disproportionately high among African American children. In a current study 46% of minority families of children with asthma reported 1-3 emergency room visits for asthma in the previous 6 months, and 43% had been hospitalized for asthma at least once. Inadequate primary care for asthma and poor adherence to asthma medications have been implicated as important factors in the high rates of emergency room care and hospitalization. No studies have examined the relative contributions of asthma primary care and medication adherence to asthma morbidity in urban minority communities. It is not known if behavioral/educational interventions can change primary care utilization or medication adherence in these communities, nor if such changes would alter asthma morbidity. In this study we will examine the impact of two home-based asthma interventions compared to a minimal contact intervention group. The Access intervention will assist families in overcoming barriers and establishing access to primary asthma health care within the community. The Access + Adherence intervention will assist families in establishing asthma primary care and appropriate adherence to prescribed asthma medications. Specifically, we hypothesize that an adherence intervention designed to both increase access to medical care and improve asthma medication knowledge and adherence will significantly reduce emergency room use for asthma care, when compared to a home-based intervention designed exclusively to increase access to care, and a minimal contact intervention. Thirty-three elementary schools in urban Baltimore, Maryland will serve as our recruitment sites. Asthmatic children grades K-5 will be identified by school records and parent surveys. Three hundred-ninety asthmatic children with one or more emergency room visits for asthma care in the past six months will be enrolled. Baseline measures will be collected after obtaining consent and prior to school randomization. Participating schools will be randomly assigned to one of three intervention groups : 1) a Control/Minimal intervention, 2) a home-based Access intervention, 3) a home-based Access + Adherence intervention. The duration of both the Access intervention and the Access + Adherence intervention will be six months. Follow-up measures will be collected from children and families at 6, 1 2, and 18 months. The primary outcome measure will be emergency care for asthma over the eighteen month follow-up. Secondary outcomes include other access to care (urgent and primary), medication adherence, barriers to health care, school absences, restricted activity, nighttime symptoms, asthma medications, self and family asthma management, functional status, and impact on family. Additional analyses will examine the relative cost- effectiveness and cost-benefits of the two home-based interventions.
