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: Lisa.chamberlain@medcenter.stanford.edu

Janine Bishop, MPH Address: Same as above Email: jbishop@stanford.edu Wk: 650-725-0923