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Internet Telehealth for Pediatric Nurse Case Management Improves Asthma Control
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Does Insurance Coverage Equal Asthma Control in SchoolAged Children? T. Kruzick, R. Covar, M. Gleason, L. Cicutto, M. White, S. Szefler; National Jewish Health, Denver, CO. RATIONALE: Health insurance and access to health providers are thought to be key to successful asthma control. METHODS: Of 728 students with asthma, 153 students completed questionnaires for participation in the Denver Public School Asthma Program. The relationship between medical insurance and presence/type of medical provider to measures of asthma severity was assessed using the likelihood ratio test. RESULTS: Demographics included: mean age 9.262.6 years; 59% male; 25.5% Black; 51.0% Hispanic; 78% qualified for reduced lunch; 89% reported having medical insurance (60% public plans); 92% reported having a physician caring for their child’s asthma (90% of which were primary care providers). In students with and without medical insurance, uniformly high rates of prednisone use (30 vs. 47%, respectively, p 5 0.2), hospitalization (39 vs. 53%, p 5 0.3), emergency care (56 vs. 67%, p 5 0.4), and uncontrolled daytime (30 vs. 27%, p 5 0.8) and nighttime symptoms (32 vs. 20%, p 5 0.3) were found. In general, low use of inhaled corticosteroids was noted regardless of medical insurance status (private: 24%, non-private: 27%, and no insurance: 20%). 58% of students with identified medical providers reported utilizing emergency care compared to 27% of those without identified providers (p 5 0.03). Both groups had high percentages reporting past hospitalization (41 vs. 31%, p 5 0.5) and low percentages using inhaled corticosteroids (26 vs. 17%, p 5 0.02). CONCLUSIONS: Despite coverage and accessibility to health providers, there were still high percentages of students with uncontrolled asthma and that did not use inhaled corticosteroids illustrating the need for programs that can identify and monitor children at risk for high asthma morbidity.
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The Effectiveness of an After School Asthma Club for Underserved Children with Asthma M. Foster1, S. Lambert2, M. Streett3, M. E. Bollinger3; 1University of Maryland Medical System, Baltimore, MD, 2Baltimore City Health Department, Baltimore, MD, 3University of Maryland School of Medicine, Baltimore, MD. RATIONALE: Numerous educational interventions to improve asthma related outcomes in underserved populations have been reported with mixed results. We sought to assess the feasibility and effectiveness of a peer driven after school asthma club for underserved children with asthma. METHODS: The asthma club was developed with the assistance of a Baltimore City School health aide. The school also received services from a free mobile asthma clinic, the BreathmobileÒ, but the asthma club was open to all children between age 6 and 10 years who attended the school. Parental consent was required and caregivers were invited to all meetings. The curriculum consisted of age appropriate review of asthma pathophysiology, medications focusing on controller vs. rescue medications and triggers. Meetings consisted of a review of the previous month’s exacerbations, a brief educational session and craft/game, peer discussion and snack. RESULTS: Six club meetings were held over the Ô07-Õ08 school year. The club was limited to 20 child participants with several children put on a waiting list. Child attendance per meeting ranged from 50-100%. Caregiver attendance at the meetings increased from 3/20 at the first meeting to 17/20 caregivers present at the last meeting. Meetings evolved from primarily moderator driven to peer driven by the end of the school year. CONCLUSIONS: Through a collaborative effort with school health personnel, the after school asthma club was very well received by Baltimore City school children and caregivers. Further study will determine the impact of the asthma club on asthma related outcomes in underserved children.
African American Parents'/Guardians' Health Literacy and Self-Efficacy and Their Child's Level of Asthma Control M. R. Wood; University of Toledo, Toledo, OH. RATIONALE: Over 31 million Americans have been diagnosed with asthma in their lifetime, with health costs of over $12 billion a year. Increases in prevalence, morbidity, and mortality have made asthma a major public health concern. African Americans are disproportionately burdened with asthma. National efforts to improve asthma care over the past decade have not reduced the Black/White gap. METHODS: A four-page valid and reliable asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. In addition, the Modified Newest Vital Sign (MNVS) for assessing health literacy was given to the parents/ guardians. RESULTS: A total of 198 interviews were conducted. There was a statistically significant relationship among the parents’/guardians health literacy levels and their perceived efficacy expectations to manage their child’s asthma. The study also found a correlation between the level of asthma control of the child and the efficacy expectations of the parent/guardian. Efficacy expectations and outcome expectations of the parents/guardians were found to be significant predictors of the child’s level of asthma control. CONCLUSIONS: There is evidence that high parental/guardian self-efficacy and successful asthma management contributes to a child with well controlled asthma. Although having adequate health literacy is ideal, it may not be necessary for a parent/guardian to successfully manage their child’s asthma with a high level of self-efficacy. It is essential for patient educators to capitalize on physician visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.
Internet Telehealth for Pediatric Nurse Case Management Improves Asthma Control K. K. Shanovich1, C. A. Sorkness1, M. E. Wise1, A. D. Pulvermacher1, A. Bhattacharya2, D. H. Gustafson1; 1University of Wisconsin - Madison, Madison, WI, 2UW Health, Madison, WI. RATIONALE: ‘‘Internet Telehealth for Pediatric Asthma Nurse Case Management,’’ an NINR-funded randomized trial, tested whether an intervention integrating telephone nurse case management with online parentfocused asthma education, the Comprehensive Health Enhancement Support System (CHESS), could improve daily controller medication adherence and pediatric asthma control, as compared to usual care. METHODS: Caregivers, and their children with poorly controlled asthma, were recruited from six health insurance organizations, and participated in an intake interview with asthma education prior to randomization. Adherence to controller medication was measured by pharmacy claims data, and asthma control by the Asthma Control Questionnaire (ACQÒ) at three-month intervals. RESULTS: 305 caregiver/child dyads enrolled; 159 (85%) completed the trial. There were no significant between-group differences at baseline. The mean child age was 7.9 (SD 2.5); the mean ACQÒ score was 2.4 (SD 1.2). The mean caregiver age was 38 (SD 9.1); 50% were non-white; 50% were unmarried; 33% had a high school education or less; and 51% were Medicaid recipients. Over the yearlong study, adherence in both CHESS and usual care groups had modest clinical, but statistically significant, improvements (P < .001); there were no between-group differences (P 5.354). However, for the ACQÒ, there were no significant temporal improvements for the usual care group (P 5 .22), but significant improvements for the CHESS group (P < .001). Further, the between-group differences were significant (P 5 .014), seen at 3 months and persisting throughout the study. CONCLUSIONS: Combining telephone nurse case management with online parent-focused asthma education (CHESS), significantly improved pediatric asthma control.
SATURDAY
Abstracts S43
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
Does Insurance Coverage Equal Asthma Control in SchoolAged Children? T. Kruzick, R. Covar, M. Gleason, L. Cicutto, M. White, S. Szefler; National Jewish Health, Denver, CO. RATIONALE: Health insurance and access to health providers are thought to be key to successful asthma control. METHODS: Of 728 students with asthma, 153 students completed questionnaires for participation in the Denver Public School Asthma Program. The relationship between medical insurance and presence/type of medical provider to measures of asthma severity was assessed using the likelihood ratio test. RESULTS: Demographics included: mean age 9.262.6 years; 59% male; 25.5% Black; 51.0% Hispanic; 78% qualified for reduced lunch; 89% reported having medical insurance (60% public plans); 92% reported having a physician caring for their child’s asthma (90% of which were primary care providers). In students with and without medical insurance, uniformly high rates of prednisone use (30 vs. 47%, respectively, p 5 0.2), hospitalization (39 vs. 53%, p 5 0.3), emergency care (56 vs. 67%, p 5 0.4), and uncontrolled daytime (30 vs. 27%, p 5 0.8) and nighttime symptoms (32 vs. 20%, p 5 0.3) were found. In general, low use of inhaled corticosteroids was noted regardless of medical insurance status (private: 24%, non-private: 27%, and no insurance: 20%). 58% of students with identified medical providers reported utilizing emergency care compared to 27% of those without identified providers (p 5 0.03). Both groups had high percentages reporting past hospitalization (41 vs. 31%, p 5 0.5) and low percentages using inhaled corticosteroids (26 vs. 17%, p 5 0.02). CONCLUSIONS: Despite coverage and accessibility to health providers, there were still high percentages of students with uncontrolled asthma and that did not use inhaled corticosteroids illustrating the need for programs that can identify and monitor children at risk for high asthma morbidity.
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155
The Effectiveness of an After School Asthma Club for Underserved Children with Asthma M. Foster1, S. Lambert2, M. Streett3, M. E. Bollinger3; 1University of Maryland Medical System, Baltimore, MD, 2Baltimore City Health Department, Baltimore, MD, 3University of Maryland School of Medicine, Baltimore, MD. RATIONALE: Numerous educational interventions to improve asthma related outcomes in underserved populations have been reported with mixed results. We sought to assess the feasibility and effectiveness of a peer driven after school asthma club for underserved children with asthma. METHODS: The asthma club was developed with the assistance of a Baltimore City School health aide. The school also received services from a free mobile asthma clinic, the BreathmobileÒ, but the asthma club was open to all children between age 6 and 10 years who attended the school. Parental consent was required and caregivers were invited to all meetings. The curriculum consisted of age appropriate review of asthma pathophysiology, medications focusing on controller vs. rescue medications and triggers. Meetings consisted of a review of the previous month’s exacerbations, a brief educational session and craft/game, peer discussion and snack. RESULTS: Six club meetings were held over the Ô07-Õ08 school year. The club was limited to 20 child participants with several children put on a waiting list. Child attendance per meeting ranged from 50-100%. Caregiver attendance at the meetings increased from 3/20 at the first meeting to 17/20 caregivers present at the last meeting. Meetings evolved from primarily moderator driven to peer driven by the end of the school year. CONCLUSIONS: Through a collaborative effort with school health personnel, the after school asthma club was very well received by Baltimore City school children and caregivers. Further study will determine the impact of the asthma club on asthma related outcomes in underserved children.
African American Parents'/Guardians' Health Literacy and Self-Efficacy and Their Child's Level of Asthma Control M. R. Wood; University of Toledo, Toledo, OH. RATIONALE: Over 31 million Americans have been diagnosed with asthma in their lifetime, with health costs of over $12 billion a year. Increases in prevalence, morbidity, and mortality have made asthma a major public health concern. African Americans are disproportionately burdened with asthma. National efforts to improve asthma care over the past decade have not reduced the Black/White gap. METHODS: A four-page valid and reliable asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. In addition, the Modified Newest Vital Sign (MNVS) for assessing health literacy was given to the parents/ guardians. RESULTS: A total of 198 interviews were conducted. There was a statistically significant relationship among the parents’/guardians health literacy levels and their perceived efficacy expectations to manage their child’s asthma. The study also found a correlation between the level of asthma control of the child and the efficacy expectations of the parent/guardian. Efficacy expectations and outcome expectations of the parents/guardians were found to be significant predictors of the child’s level of asthma control. CONCLUSIONS: There is evidence that high parental/guardian self-efficacy and successful asthma management contributes to a child with well controlled asthma. Although having adequate health literacy is ideal, it may not be necessary for a parent/guardian to successfully manage their child’s asthma with a high level of self-efficacy. It is essential for patient educators to capitalize on physician visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.
Internet Telehealth for Pediatric Nurse Case Management Improves Asthma Control K. K. Shanovich1, C. A. Sorkness1, M. E. Wise1, A. D. Pulvermacher1, A. Bhattacharya2, D. H. Gustafson1; 1University of Wisconsin - Madison, Madison, WI, 2UW Health, Madison, WI. RATIONALE: ‘‘Internet Telehealth for Pediatric Asthma Nurse Case Management,’’ an NINR-funded randomized trial, tested whether an intervention integrating telephone nurse case management with online parentfocused asthma education, the Comprehensive Health Enhancement Support System (CHESS), could improve daily controller medication adherence and pediatric asthma control, as compared to usual care. METHODS: Caregivers, and their children with poorly controlled asthma, were recruited from six health insurance organizations, and participated in an intake interview with asthma education prior to randomization. Adherence to controller medication was measured by pharmacy claims data, and asthma control by the Asthma Control Questionnaire (ACQÒ) at three-month intervals. RESULTS: 305 caregiver/child dyads enrolled; 159 (85%) completed the trial. There were no significant between-group differences at baseline. The mean child age was 7.9 (SD 2.5); the mean ACQÒ score was 2.4 (SD 1.2). The mean caregiver age was 38 (SD 9.1); 50% were non-white; 50% were unmarried; 33% had a high school education or less; and 51% were Medicaid recipients. Over the yearlong study, adherence in both CHESS and usual care groups had modest clinical, but statistically significant, improvements (P < .001); there were no between-group differences (P 5.354). However, for the ACQÒ, there were no significant temporal improvements for the usual care group (P 5 .22), but significant improvements for the CHESS group (P < .001). Further, the between-group differences were significant (P 5 .014), seen at 3 months and persisting throughout the study. CONCLUSIONS: Combining telephone nurse case management with online parent-focused asthma education (CHESS), significantly improved pediatric asthma control.
SATURDAY
Abstracts S43
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2