Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty

Abstract

In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned: 1) the importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) the need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) the need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma. The primary intervention for our original School-Based Asthma Therapy program was directly observed administration of preventive asthma medications in school (with dose adjustments on the basis of National Heart, Lung, and Blood Institute guidelines). We found that children who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures. Our subsequent asthma programs have focused on dissemination and sustainability, with the incorporation of communication technology to enhance the system of care. We are currently testing the 'School-Based Telemedicine Enhanced Asthma Management' program, including 400 children with persistent asthma from the Rochester City School District. This program includes directly observed administration of preventive asthma medication at school, and school-based telemedicine to assure appropriate evaluation, preventive medication prescription, and follow-up care. It is designed to implement and sustain guideline-based asthma care through existing community infrastructure, and could serve as a model for the integration of services in rural as well as urban communities.

Keywords: asthma; chronic illness; prevention; telemedicine.

Figure 1. Summary of Study Design

Figure 1 outlines the process of events for the SB-TEAM study. Children are identified through telephone screening at the start of the school year and a home visit is scheduled for the baseline assessment. Children assigned to the SB-TEAM group are then scheduled for an initial telemedicine visit to determine the appropriate treatment to be initiated as DOT at school. The subsequent 2 telemedicine visits are used to reassess symptoms and determine whether a step-up in therapy is needed. Any changes in treatment are implemented through school-based DOT. Both groups are followed over time by blinded interviewers, assessing a variety of outcomes until the end of the school year.