August 2003

Grant Results

SUMMARY

In 2002, the Spirit of Caring Mobile Health Clinic, which provides primary health care to low-income, uninsured children in the Chula Vista Elementary School District in Southern California, expanded its services to include asthma education, screening and treatment.

The clinic — a joint effort of the school district and two nonprofit health systems, Sharp HealthCare and Scripps Health — serves children enrolled in schools with the highest rate of absenteeism and children referred by other schools.

Key Results

  • In 2002, project staff held 407 individual educational sessions for children and parents and treated 218 children.
  • Through the project, 348 children obtained "Asthma Action Plans." These plans tell a child how much medication to take and when, based on his or her physical condition and peak flow measurement at any given time.
  • The project director reported a decrease in acute asthma episodes among students who received mobile health clinic interventions and followed the guidance they received.
  • No students who received services reported subsequent hospitalization or emergency room treatment during the project period.

Funding
Sharp HealthCare launched the asthma initiative with a one-year $49,832 grant from the Robert Wood Johnson Foundation (RWJF).

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THE PROBLEM

Border regions of the country frequently experience gaps in access to care. This can significantly impact the health of children with asthma. Although general primary care is often provided, not all children have the opportunity to be tested, and health care service providers are often not equipped to detect or treat asthmatic children. A 1998 study by Sharp HealthCare and school nurses found that up to 10 percent of Chula Vista students required further medical follow-up or treatment for asthma.

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THE PROJECT

Working with a seven-member committee of local health care professionals, project staff developed an implementation plan that targeted children with undiagnosed asthma or severe, uncontrolled asthma, and those who lacked adequate medication. To identify children who should receive assistance, the project staff reviewed charts of pediatric asthma patients seen in the Sharp Chula Vista Medical Center Emergency Department. They also publicized the new asthma services by distributing a flyer that described asthma symptoms in English and Spanish to parents and members of the community.

The staff also consulted with the American Lung Association and the San Diego Asthma Coalition about appropriate educational information and bilingual materials and ensured that its asthma services followed national guidelines. Educational materials supplied to children and their parents covered early recognition of symptoms, potential episode triggers and the use of medication and peak flow measurements (the rate at which a person can exhale). Participating children received attendance incentives such as free peak flow meters, trial medication, literature and videos concerning asthma treatment.

To evaluate the project's effectiveness, the staff measured the increase in identification of students with uncontrolled asthma and the rate of improvement in asthma treatment and control among children in the school district.

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RESULTS

Sharp HealthCare Foundation reported the following results to RWJF:

  • In 2002, the project held 407 individual educational sessions for children and parents and treated 218 children. Staff also conducted small-group or classroom asthma education sessions for 164 students, many coordinated with the American Lung Association's Lung Express mobile teaching unit.
  • Some 130 students received spirometry testing, a measure of lung functioning. Of these, 14 students had abnormal results and no history of asthma or related conditions.
  • Through the project, 348 children obtained "Asthma Action Plans." These plans tell a child how much medication to take and when, based on his or her physical condition and peak flow measurement at any given time.
  • The project offered three one-hour special education sessions for high-risk asthmatic children with poorly controlled asthma. Some 42 students attended one of the seven sessions, which included detailed testing and evaluation, diagnosis and treatment.
  • The project director reported a decrease in acute asthma episodes among students who received mobile health clinic interventions and followed the guidance they received. In addition, no students who received services reported subsequent hospitalization or emergency room treatment during the project period.

Communications

The San Diego Union Tribune provided coverage about the mobile clinic's asthma project. The nurse practitioner with the project gave a presentation regarding the asthma component at the International CHEST (American College of Chest Physicians) conference in San Diego in November 2002.

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LESSONS LEARNED

The project director reported the following lessons to RWJF:

  1. Lack of teleservice and transportation as well as family members' inability to take time off work can cause chronic missed appointments among this population. In this project, staff members sent postcard reminders, facilitated transportation with community and school resources and provided medical-excuse notes to parents for their employers. (Project Director)
  2. General spirometry screening does not necessarily identify enough undiagnosed asthmatics to warrant testing high numbers of students year round. It is best to concentrate this testing in the winter months when more patients are apt to experience some decrease in lung function because of the weather and seasonal infection rates. (Project Director)
  3. Without assistance in obtaining medication, compliance by this population is likely to be low. The project staff found that only about 10 percent of families without health insurance were able to purchase adequate medication. (Project Director)

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AFTER THE GRANT

The mobile clinic staff is integrating the asthma component into its regular program of services; the grantee organization is researching funding opportunities to assure its continuation.

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GRANT DETAILS & CONTACT INFORMATION

Project

Providing Asthma Screening, Education and Treatment in a Border Region

Grantee

Sharp HealthCare Foundation (San Diego,  CA)

  • Amount: $ 49,832
    Dates: January 2002 to December 2002
    ID#:  042092

Contact

Sylvia A. Salas, M.P.H.
(858) 499-4815
sylvia.salas@sharp.com

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Prepared by: Janet Spencer King
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Pamela S. Dickson