ASTHMA MANAGEMENT &EDUCATION PROGRAM: A general
pediatric training program partnering with schools to control asthma
Lisa Chamberlain, MD, MPH
Laurie Bauer, RN, MPH
Janine Bishop, MPH
APHA
November 2004
Presentation Summary
Collaborative partnership Primary partners Strategic plan Asthma resources &
classes Results & evaluation Conclusion
Collaborative Partnership
1. Ravenswood City School District (RCSD), East Palo Alto, CA
2. Pediatric Residents from an academic medical center
3. Local pediatric providers (County and community clinics, private practice)
4. Community-based organizations (CBOs)
Objective: To test the feasibility of a population-based approach to improve the health outcomes for asthmatic children, by developing a partnership between:
Primary Partners
Ravenswood City School District (RCSD)District Nurse
Pediatric Interns
Ravenswood City School District
70%
8% 2%
20%
HispanicAfrican AmericanPacific IslandOther
1 District Nurse 4,800 students–12 schools
Grades (K-8) 85%–Free/Reduced lunches High number of immigrant
families 70% speak Spanish at home Many single parent
households
Pediatric Interns
Pediatric Interns Lucile Packard Children’s
Hospital (LPCH), Palo Alto, CA
Community Advocacy Rotation
Intern class project Year long asthma project Meeting w/ District Nurse Needs assessment w/ RCSD Class vote
Asthma in Ravenswood
Hospitalization rate for EPA children three times higher than other areas in San Mateo County
Lack of access to medical care Sub-optimal housing (triggers from molds, mildews, cockroaches,
dust mites) Located next to SF Bay and Industrial pollution
Strategic Plan
Strategic Plan
Project activities: Responsible partner: Identify pediatric asthmatics RCSD District Nurse
Conduct needs assessment w/
local pediatricians/pharmacists
Pediatric residents
Define asthma mgt. goals Individual children RCSD Schools Local pediatricians
RCSD District Nurse Pediatric residents
Promote comprehensive asthma management
Asthma Case Mgr. Collaborative group
Identified Priority Areas
RCSD: 319 self-reported pediatric asthmatics (K-8) in ’03-’04
Less than 1% carry inhalers to school
Local needs assessment: Most pediatricians do not adhere to NHLBI (Nat. Heart
Lung Blood Inst.) asthma standards Children do not have asthma plans Pediatricians willing to adopt guidelines w/ education
and resources Pharmacists report MDs prescribing medications not
covered by insurance
Individual child goals
Objectives Activities Correct medications prescribed Resources created to
ensure standard of care Peak flow meters (not covered
by health plan)
Donations of peak flow meters
Asthma plans Outlined by MDs Flu shot each fall Recommend flu shots Parent/child asthma class Resident run classes Home visits by trained home
visitors
Referrals to home visiting program
School-based asthma case manager Hire asthma case mgr.
RCSD Goals
Objectives Activities Identify asthmatics Self-reported asthma
on Emergency cards Student asthma plan & med.
authorization on file at each school Work w/ school
admin. Open Airways curriculum For asthmatics (grades
3-5) Train staff & teachers Resident led asthma
trainings Asthma classes for all parents
& students
Resident led asthma classes
Local Physician Goals
Objectives: Resources: Prescribe appropriate meds. Asthma cards
Medications covered by local health plans
Discuss asthma action plans
w/ parents & children Give copy to parents Fax copy to school
Asthma action plans Plans tell family what to
do to PREVENT attacks
Medication stamps
Distribute peak flow meters Peak flow meters for students
Asthma Resources & Classes
Asthma Action Plan
Asthma plan written by doctor Controller meds, dose, instruct. Relief meds, dose, instruct.
3 Zones: Green-No asthma
(PREVENTION) Yellow-Not well (CAUTION) Red-Feels awful (MED ALERT)
3 Copies: Patient, School/Other, Chart
*Asthma Action Plan courtesy of RAMP
Asthma Med Cards for MDs
Approved Asthma Meds Local Health Plan
approved Drug, formulation, dose
(low, med, high)
NHLBI Guidelines Asthma classification Symptoms Treatment (age dependent)
Teacher/School Trainings
Resident developed and led trainings.
Topics covered: What is asthma? How to recognize an
asthma attack How to help students
manage asthma How to use an inhaler
Conducted at 8 schools
Parent/Student Asthma Classes
Residents organized bilingual asthma management classes for parents and children.
Physicians training teachers
Teachers training parents and students
2 classes: 1 Eng & 1 Spanish
Home Visitor Program
Home Visitor Program administered by a local CBO.
Program: Home visitors trained in
asthma management Assess indoor air quality
(IAQ) and asthma triggers (mold, smoke, drapes, mattress covers, stuffed animals, etc.)
Results & Evaluation
Results
Children & RCSD: 319 pediatric asthmatics identified (RCSD) 96 children and 16 teachers/staff received Open
Airways training 160 teachers/staff received general asthma training 30 parents and 18 students attended asthma classes Asthma Case Manager grant ($33,000)Physicians: 80% local physicians adopted asthma plan 200 asthma med/treatment cards distributed
Evaluation
1. Plan to evaluate ER/hospitalization data 3 years prior (2000-2003) 3 years after (2004-2007)
2. Compare pharmacy data Ratio of controller to rescue
medication prescription rate (Health Plan data)
3. Geographical Information Systems Mapping to facilitate community
based research and hypothesis generation
Conclusion
Conclusion
Demonstrated impact on asthma care in the physician office, school and home.
Educated residents re: role of MDs in the community as they provided local county with resources.
Evaluation of impact on asthma morbidity is underway.
Acknowledgements
Ravenswood City School District Pediatric intern class from LPCH Local community based organizations East Palo Alto Asthma Task Force Participating parents and asthmatic children
Thank you for your attention! We can make a difference in the health of children!
Contact Information
Lisa Chamberlain, MD, MPH Address: 750 Welch Rd, Suite 325, Palo Alto CA 94301 Email: [email protected]
Janine Bishop, MPH Address: Same as above Email: [email protected] Wk: 650-725-0923