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Lisa Chamberlain, MD, MPH Laurie Bauer, RN, MPH Janine Bishop, MPH APHA November 2004

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

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Lisa Chamberlain, MD, MPH Laurie Bauer, RN, MPH Janine Bishop, MPH APHA November 2004

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  1. 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

  2. Presentation Summary • Collaborative partnership • Primary partners • Strategic plan • Asthma resources & classes • Results & evaluation • Conclusion

  3. Collaborative Partnership • Ravenswood City School District (RCSD), East Palo Alto, CA • Pediatric Residents from an academic medical center • Local pediatric providers (County and community clinics, private practice) • 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:

  4. Primary Partners Ravenswood City School District (RCSD) District Nurse Pediatric Interns

  5. 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

  6. 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

  7. 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

  8. Strategic Plan

  9. Strategic Plan

  10. 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

  11. Individual child goals

  12. RCSD Goals

  13. Local Physician Goals

  14. Asthma Resources & Classes

  15. 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

  16. Asthma Med Cards for MDs

  17. 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

  18. 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

  19. 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.)

  20. Results & Evaluation

  21. 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

  22. Evaluation • Plan to evaluate ER/hospitalization data • 3 years prior (2000-2003) • 3 years after (2004-2007) • Compare pharmacy data • Ratio of controller to rescue medication prescription rate (Health Plan data) • Geographical Information Systems • Mapping to facilitate community based research and hypothesis generation

  23. Conclusion

  24. 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.

  25. 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

  26. Thank you for your attention! We can make a difference in the health of children!

  27. 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

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