Magazine article Clinical Psychiatry News

Asthma Outreach Program Poised to Expand; New York City-Based Initiative Estimates Cost per Underserved Pediatric Patient Is Down by $4,490

Magazine article Clinical Psychiatry News

Asthma Outreach Program Poised to Expand; New York City-Based Initiative Estimates Cost per Underserved Pediatric Patient Is Down by $4,490

Article excerpt

MIAMI BEACH -- Physicians who run a successful outreach and treatment program for underserved, inner-city children and adults with asthma plan to expand nationwide once they determine the essential and cost-effective components.

The overall prevalence of asthma among children in the United States is 12%, according to data from the National Center for Health Statistics' National Survey of Children's Health, 2003.

However, the prevalence is much higher in specific communities, particularly in inner-city areas. For example, children in New York City's central Harlem community have a lifetime pediatric asthma prevalence rate of 30%, according to the Harlem Children's Zone program (www.hcz.org/project/new.html).

"We did a study of [1,636] homeless kids, using shelter-based surveillance, and found 33% had moderate to severe asthma," Dr. Irwin Redlener said. This group included 16% who had symptoms but no prior diagnosis (Am. J. Public Health 2007;97:448-50).

The Children's Health Fund began an outreach and treatment program in 1987 using a mobile home to give children in New York City homeless shelters "a medical home," said Dr. Redlener, president of the fund and associate dean of public health advocacy and preparedness at Columbia University, New York.

The Childhood Asthma Initiative (CAI) is an essential component of the Children's Health Fund, Dr. Redlener said. "Asthma is a chronic condition that needs a lot of organized follow-up. It is extraordinarily difficult [to manage] in the absence of a medical home."

The program expanded citywide to include a fleet of four mobile outreach units, a clinic near Montefiore Medical Center in the South Bronx, and a new school-based health care program in Harlem. The success of the program spurred expansion to establish Children's Health Fund National Network sites around the country, including mobile units still in the gulf area following Hurricane Katrina.

The outreach works. Investigators found significant increases in medication use and decreases in emergency department visits and hospitalization rates. For example, after 1 year, the use of appropriate asthma controller medications in 202 homeless and low-income-housed asthma patients (average age, 7 years) increased from 49% to 75%. "It's still not perfect," Dr. Redlener said. Initial use was even lower in the cohort of children in homeless shelters (34%), but this likewise increased to 75% after 1 year. …

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