Transcript ASTHMA 101: - Stanford University

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
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Collaborative partnership
Primary partners
Strategic plan
Asthma resources &
classes
 Results & evaluation
 Conclusion
Collaborative Partnership
Objective: To test the feasibility of a
population-based approach to improve the
health outcomes for asthmatic children, by
developing a partnership between:
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)
Primary Partners
Ravenswood City School District (RCSD)
District Nurse
Pediatric Interns
Ravenswood City School District
8% 2%
20%
70%
Hispanic
African American
Pacific Island
Other
 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
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Lucile Packard Children’s
Hospital (LPCH), Palo Alto, CA
 Community Advocacy
Rotation
 Intern class project
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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
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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
 Define asthma mgt. goals
 Individual children
 RCSD Schools
 Local pediatricians
 Pediatric residents
 Promote comprehensive asthma
management
 Asthma Case Mgr.
 Collaborative group
 RCSD District Nurse
 Pediatric residents
Identified Priority Areas
RCSD:
 319 self-reported pediatric asthmatics (K-8) in ’03-’04
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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.
 Work w/ school
authorization on file at each school
admin.
 Open Airways curriculum
 For asthmatics (grades
3-5)
 Train staff & teachers
 Asthma classes for all parents
& students
 Resident led asthma
trainings
 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
 Asthma action plans
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Give copy to parents
Fax copy to school
 Distribute peak flow meters
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Plans tell family what to
do to PREVENT attacks
 Medication stamps
 Peak flow meters for
students
Asthma Resources & Classes
Asthma Action Plan
 Asthma plan written by doctor
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Controller meds, dose, instruct.
Relief meds, dose, instruct.
 3 Zones:
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Green-No asthma
(PREVENTION)
Yellow-Not well (CAUTION)
Red-Feels awful (MED ALERT)
 3 Copies:
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Patient, School/Other, Chart
*Asthma Action Plan courtesy of RAMP
Asthma Med Cards for MDs
Approved Asthma Meds
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Local Health Plan
approved
Drug, formulation, dose
(low, med, high)
NHLBI Guidelines
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Asthma classification
Symptoms
Treatment (age dependent)
Teacher/School Trainings
 Resident developed
and led trainings.
 Topics covered:
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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:
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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
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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
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Address: 750 Welch Rd, Suite 325, Palo Alto CA 94301
Email: [email protected]
 Janine Bishop, MPH
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Address: Same as above
Email: [email protected]
Wk: 650-725-0923