Stephanie Tsao

Rationale: Socioeconomically disadvantaged patients with asthma and/or chronic obstructive pulmonary disease (COPD) face barriers to evidence-based care that are difficult to overcome in health care settings with limited resources. Objectives: Evaluate the efficacy of a pulmonary-specialist-health coach consultation model (intervention) for patients with asthma and/or COPD, relative to usual care (control). Methods: Randomized-controlled trial of 16 weeks of intervention versus control for adult English- or Spanish-speaking, low-income patients. Intervention: a lay health coach gathered information from the patient and medical record for remote review by a pulmonary specialist, who provided general recommendations to the primary care clinician. The coach supported implementation of recommendations. Measurements: Primary outcomes were receipt of guideline-based care and medications. Secondary outcomes were receipt of chronic lung disease education, breathing-related quality of life and symptoms, patient-rated quality of care, and adherence to inhaler therapy. Longitudinal models for count data were used to estimate Intervention: Control relative rates. Parallel models for continuous data estimated relative means. Main results: 165 intervention participants received 1.61-fold more guideline-based care than 163 control participants (relative ratio; CI: 1.37-1.90). They were not more likely to receive guideline-based medications in planned analysis using a pooled baseline rate, although post-hoc analysis using arm-specific baseline rates found significant improvement. Intervention patients received more chronic lung disease education and reported greater improvements in breathing-related quality of life, symptoms, and patient-reported quality of care. Conclusions: This intervention offers a scalable approach to improve uptake of clinical guidelines in resource-limited primary care practices managing most asthma and COPD care.