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Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review
India Gill1, Aashna Shah1,2, Eun Kyung Lee1,3
1Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.
Insights
Community interventions significantly reduce childhood asthma exacerbations, decreasing emergency department visits and hospitalizations. These programs improve health equity by addressing social and environmental factors impacting vulnerable populations.
Area of Science:
- Public Health
- Environmental Health
- Health Equity
Background:
- Childhood asthma inequities are linked to structural and social determinants within segregated communities.
- Black, Hispanic, and low-income populations are disproportionately affected by childhood asthma.
- Community interventions offer a promising approach to mitigate healthcare disparities.
Purpose of the Study:
- To systematically review the effectiveness of community interventions for childhood asthma.
- To develop a conceptual model for implementing future community-based asthma interventions.
- To assess the impact on emergency healthcare utilization and co-benefits.
Main Methods:
- Systematic review of studies published between 2010-2021 from multiple databases and hand searches.
- Inclusion criteria focused on community interventions for children with asthma, excluding school or hospital-only programs.
- Data extraction included emergency department visits, hospitalizations, and co-benefits like reduced missed school/work days.
Main Results:
- Twenty-six publications met inclusion criteria, categorizing interventions into care coordination, policy/environmental changes, home-based, and community health services.
- Community interventions demonstrated significant reductions in childhood asthma emergency department visits and hospitalizations.
- Mechanisms included enhanced caregiver self-efficacy, reduced home environmental triggers, and improved healthcare access.
Conclusions:
- Community interventions are associated with reduced emergency healthcare use for severe childhood asthma cases.
- These interventions show a protective effect, improving health outcomes for affected children.
- Findings support the implementation of community-based strategies to address childhood asthma disparities.
Abstract:
A systematic review of interventions in community environments found significant reductions in childhood asthma exacerbations leading to emergency department visits and hospitalizations.
Background And Objectives:
Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions.
Methods:
Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays).
Results:
Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis.
Conclusions:
Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.
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