Effectiveness of a promotora home visitation program for underserved Hispanic children with asthma

Objective: Retention in a mobile asthma clinic, the Breathmobile (TM), of >= 3 visits has previously been shown to be essential for attaining asthma control in underserved children. The objective of this study in primarily Hispanic-American children was to determine the difference in retention between those seen in the Breathmobile (TM) compared to those receiving an additional promotora-based home visit (HV). Methods: Children with asthma in the Breathmobile (TM) program were evaluated for asthma status and aeroallergen sensitivity. Indication for HV included poor asthma control, educational and environmental control needs. An initial visit consisted of environmental assessment as well as a 3-h interactive educational session covering asthma basics. A follow-up visit 1 month later assessed implementation. The primary outcome measure of retention was >= 6 months in the Breathmobile (TM) program. Results: Of the 1007 asthmatic children seen between April 2002 and June of 2005, 136 received HV. These children showed significantly greater retention compared to those without HV with a median number of visits (5 visits versus 2 visits), >= 3 Breathmobile (TM) visits (86.0% versus 38.8%), median number of days in the program (299 versus 63 days) and percentage of patients in the program >= 6 months (67.8% versus 31.3%) p < 0.001. HV and asthma severity were each independent predictors of retention. Conclusions: The addition of a promotora HV program proved effective in providing greater retention in the Breathmobile (TM) program essential for asthma control. Randomized clinical trials will be needed to show the impact on health care utilization and asthma control.