Asthma:Shared Medical

AppointmentsDr. Jill Batson

http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/

Asthma is a chronic lung disease that affects the lungs in two ways; by narrowing of the airways in bronchospasm and with inflammation and mucous production.

http://www.cdc.gov/nchs/fastats/asthma.htm

Asthma is one of the most common childhood illnesses seen by health care professionals

2011 & 2010 US statistics Number of children who currently have asthma: 7.1 million Percent of children who currently have asthma: 9.5% Number of visits to physician offices with asthma as primary diagnosis: 14.2 million Number of visits to emergency departments with asthma as primary diagnosis: 1.8

million Number of deaths: 3,404

http://www.dshs.state.tx.us/asthma/reports.shtm

In Texas in 2009 there were 538,000 children (8.2%) and 1.2 million adults (6.5%) who had a current diagnosis of asthma.

That year there also 28,000 hospitalizations reported for asthma for all age groups in Texas

This burden of disease comes at a steep price. In 2010, Texas Medicaid reimbursements for professional, outpatient and inpatient hospital claims for asthma were approximately $60.5 million

Parkland Health & Hospital System is Dallas County’s public hospital and is the primary care provider for many low income patients.

Parkland consists of a hospital facility and a network of community-based (COPC)and school-based clinics.

In 2003 the COPC administration convened an asthma force that included health care professionals and community organizations.

The group decision made the decision to use SMA’s (Shared Medical Appointment) to help address the problem of childhood asthma

PHHS partnered with DISD SMA’s began in 2005-06 school year, initially in the 75217 zip code. This

area was determined by the task force to have the greatest need

Shared Medical Appointments

SMA team

• MD, Nurse, Educator and business staff

• PHHS and CMC

DISD • School Nurse• Administrators

Family

• Smoking Cessation• Asthma education

Shared Medical Appointments

Shared Medical Appointments are typically scheduled on a monthly basis.

School Nurse identifies patients appropriate for program Screening questionnaires have been also been used in the past Patients without primary care providers may be referred to Youth

and Family centers

Shared Medical Appointments

SMAs occur on site at school at the end of day Held in Library or Multipurpose room Health educator provides interactive asthma information to students and

parents Nurse performs screening and vital signs Health care provider provides exam and medication. Family and the school nurse have access to team for questions by phone or

through Youth and Family centers between site visits

Shared Medical Appointments

At initial visit patients are given Spacer, Peak Flow Meter and Asthma Action Plan Physician follows standardized guidelines recommended by the NHLBI (The

National Heart, Lung, and Blood Institute) for the Diagnosis and Management of Asthma. NHLBI provides protocols in the treatment of diseases such as asthma.

Health educator follows a standardized curriculum- including “What is Asthma, Asthma Action Plans”

Shared Medical Appointments

In 2011-12 the SMAs served 14 DISD schools, registered 168 students and had and average of 5 students per visit

In 2012-13 the SMAs served 12 schools, registered 153 students and served an average of 6 student per site visit

Many of the students seen at the SMA who did not have a primary care doctor were referred on to PHHS Youth and Family centers where the continue to follow for comprehensive care after SMA was completed

Shared Medical Appointments

Over the last 6 years the Shared Medical visits have successfully seen a reduction in the need for outside medical interactions for asthma as well as an improvement in many quality of life factors including

ER visits Missed days of school Night time awakenings for cough Daily rescue inhaler use

Most patient showed improvement in their understanding of rescue vs. controller medicine as well asthma action plan and spacer use

Shared Medical Appointment

The SMA team maintains ties to well established schools while engaging new schools where a significant need exists

They continue improve on the curriculum and communicate in a manner that facilitates learning in English and Spanish to reach parents and students.

Improved understanding about the disease process and regular medical care will help more Texas children with Asthma live healthy and active lives

Questions