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  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

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 ObjectivesActivities  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 ObjectivesActivities  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 ( )  3 years after ( ) 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

 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  Janine Bishop, MPH Address: Same as above Wk: