Interdisciplinary Care for Improved Asthma Control in Low Income and Immigrant Children
Crystal Shen, MD, MPH, FAAP
On July 31, 2019, Public Health Seattle-King County’s Eastgate clinic held its third annual Asthma Day, a clinic event focused around asthma education and preventative care. Clinic staff work together to design a half day filled with interdisciplinary care including physician visits, spirometry, medication/inhaler teaching, and asthma education. Objectives include improving families’ knowledge about asthma management and reducing asthma triggers, with a goal of improving asthma control and reducing exacerbations (and ultimately decreasing hospitalizations and emergency department visits).
Asthma Day usually is held in the summer to help prepare children for the upcoming school year by equipping them with medication and school forms before school starts. Asthma Day effectively helps increase access to medical homes and asthma care. The event includes in-person interpreters for non-English speaking families to reduce health disparities based on language and immigrant status. Eastgate’s pediatric patient population is 100% Medicaid, with mostly low income and immigrant families. There are many non-English speaking families and a high percentage of interpreted visits, especially in Spanish.
Children were selected for invitation to participate based on a variety of factors including history of asthma exacerbations and potential for optimizing asthma control. Siblings and parents were encouraged to participate.
An Asthma Day visit included multiple components for each patient. There was a pediatrician visit with ACT questions completed by MAs and individualized counseling for patients. Nurses completed spirometry. Pharmacists filled patient prescriptions ahead of time and provided inhaler + spacer teaching including use of a device to test effective inhaler use. Nurses assisted in preparing individual school asthma medication forms, which were completed by pediatricians. There also was an asthma-focused community health fair that had different stations set up. The stations included WIC nutrition, dental, pharmacy, and the King County Asthma Program. The asthma program showcased strategies for reducing environmental asthma triggers and provided free safe home cleaning kits.
Patients received a colorful Asthma Day “passport” stamped at each station. At the end, they received a certificate and prize. Families were able to enjoy healthy snacks and games outside to promote healthy nutrition and exercise.
According to surveys, families enjoyed the event and considered the programming to be very educational. Some comments on what they learned included: “To improve health by eating the right food and also by keeping household free of commercial cleaners. Also technique to use the inhaler was helpful because we weren’t doing it the ideal way.” Another family learned “what’s toxic and non-toxic in cleaning products.”
Having a systematic approach to identifying patients with asthma and inviting them for opportunities to optimize asthma control and improve asthma education can be beneficial in multiple ways. An event like Asthma Day is well received by families, can lead to decreased asthma exacerbations, and may lead to improved asthma measures. Our Asthma Day event highlighted how important interdisciplinary efforts and education are, and our staff thoroughly enjoyed planning a fun and festive event focused on prevention.