Academic journal article Journal of School Health

Community Collaboration: Concurrent Physician and School Nurse Education and Cooperation Increases the Use of Asthma Action Plans

Academic journal article Journal of School Health

Community Collaboration: Concurrent Physician and School Nurse Education and Cooperation Increases the Use of Asthma Action Plans

Article excerpt


* To encourage primary care physicians (PCPs) to use written asthma action plans

* To develop a system to communicate asthma action plans with school nurses

* To organize a community meeting to discuss asthma resources available to school nurses

* To empower and support school nurses to implement an asthma education program


In 2001, the Vermont Department of Health (VDH) identified improving asthma care as a public health priority, leading to the development of a Vermont asthma action plan. (1) Steps toward the plan's statewide implementation focused separately on groups of PCPs, school nurses, and insurers. The VDH created a manual for managing asthma in schools and sent a copy to every school. The VDH also offered Envision, a program that assists schools with creating and implementing environmental health management plans by educating schools on environmental health issues and providing them with sustainable means to identify, prevent, and address potential environmental health and indoor air quality issues. The American Lung Association of Vermont (ALA-VT) offered training for school nurses to teach Open Airways for Schools (OAS), an effective asthma self-management curriculum for children aged 8-11 years. (2) Statewide efforts by the VDH and the Vermont Department of Education also engaged schools in implementing the coordinated school health model?

Despite these actions, few PCPs were using the asthma action plan or the chronic care model, a framework for delivering high-quality care for chronic conditions, (4) to guide care for asthma. Communication of asthma action plans between PCPs and school nurses was infrequent. Many school nurses described barriers to teaching OAS. Finally, none of the schools participating in this pilot had implemented the coordinated school health model or the Envision program.


This case study describes a community approach to encouraging the exchange of information using the Vermont asthma action plan and to educating and empowering school nurses to provide asthma education in their schools. This effort used concurrent interventions with school nurses in 2 SUs and with PCPs caring for students from these SUs. The Vermont Child Health Improvement Program (VCHIP), a measurement-based program at the University of Vermont, conducted the pilot in collaboration with the VDH with partial funding from Medicaid. A pediatrician with expertise in asthma education and a quality improvement nurse led the team. The pilot was guided by the chronic care model and the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma of the National Asthma Education and Prevention Program (NAEPP). (5)

School nurses need to have asthma action plans for school-aged children on file at the school for the following reasons:

* The PCP's signature on the asthma action plan authorizes the school nurse to administer prescribed medications for prevention and treatment of asthma symptoms.

* Written asthma action plans provide the school nurse with information necessary to provide individualized teaching and reinforce self-management skills for students with asthma.

* Completed asthma action plans increase the nurse's understanding of students' needs to inform education efforts with school faculty, parents, and community.

Of 8 SUs invited to participate in the pilot, 2 agreed. The project then solicited the participation of PCPs of children attending schools in these SUs with a goal of recruiting at least 2 PCP practices for each SU. In SU #1, almost all students receive primary care from 2 sites; both PCPs from these sites agreed to participate. In SU #2, students receive health care from multiple pediatric and family practice sites spread over a wider geographic area; one of those sites agreed to participate.


Table 1 summarizes demographic measures for the 2 participating school supervisory unions (SUs), which are located in rural northern and southwestern Vermont. …

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