Academic journal article Journal of School Health

Asthma Outcomes at an Inner-City School-Based Health Center

Academic journal article Journal of School Health

Asthma Outcomes at an Inner-City School-Based Health Center

Article excerpt

In many parts of the United States, childhood asthma has reached epidemic proportions. Affecting more than 3 million American children and their families,[1] asthma ranks as the most common chronic disease in children and represents the leading cause of school absenteeism, accounting for more than 10 million days lost from school annually.[2] In addition to its morbidity and disruptive effects on families and schools, the economic costs of asthma are large. In 1995, direct medical expenditures for asthma for children ages 17 or under in the United States totaled $465 million, 73% of which went for emergency department or hospital use. Added to this is $726 million in caretakers' time lost from work.[3]

Childhood asthma poses a particular concern in large urban settings, with higher asthma prevalence and higher hospitalization and mortality rates due to asthma than in non-urban settings.[4] Children from inner cities report difficulty receiving care, experience high rates of sensitivity to environmental allergens, and commonly are exposed to environmental tobacco smoke. Accompanying this higher prevalence is increasing evidence that inner-city children may be inadequately diagnosed and treated for asthma, and that prevention and educational interventions have been underused.[5] Furthermore, research suggests successful asthma management depends on avoiding triggers, adjusting management to symptoms, and adhering to chronic asthma therapy. For many families faced with multiple social and economic challenges, these tasks are not easily accomplished. Programs that report success generally offer components tailored to the patient's individual needs.[6-8]

A growing consensus suggests that health care providers and the communities in which they work need to enact more proactive and innovative asthma control strategies. Children spend, on average, 7-10 hours a day in school. As a result, schools have become an important site for intervening in asthma care.[9] While schools have an interest in reducing barriers to learning that asthma and other health problems present, dealing with chronic illness management falls outside the scope of health services traditionally available in school settings. Yet, growing recognition suggests school systems enjoy a unique position to contribute to a population-based approach to health and to reach children where they spend many of their waking hours -- in school.

School nurses offer one potential source of intervention. Calabrese et al[9] documented that, while most school nurses have a "generally acceptable" level of knowledge about asthma, actual engagement with asthma issues varies, and some practices could be improved. This study assessed another type of intervention, one through an inner-city, elementary school-based health center that placed special emphasis on asthma.

METHODS

This study was approved by institutional review boards at the University of Minnesota, Minneapolis (Minn.) Public Schools, and Minneapolis Children's Health Care.

Setting

This study was conducted in an inner-city neighborhood school in Minneapolis, Minn., serving approximately 1,300 children grades preschool through eighth. A school-based health center began operation at the site during 1996, as part of an effort to test how health plans could work collaboratively to improve children's health. Several health plans and a local children's hospital provided funding for the health center which is staffed by a nurse practitioner, case manager, health educator, and medical assistant. In addition, the children's hospital provided physician and hospital back up.

In preparation for opening the health center, planners conducted a needs assessment. Based on a survey of 400 randomly sampled families whose children attended the school, prevalence of asthma was approximately 17% [+ or -] 4%.[10] The significant morbidity and absenteeism attributed to asthma at the school led to a decision that the health center should focus some of its effort to address asthma. …

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