By: Michelle Cloutier, MD

Asthma is the most common chronic disease that children are diagnosed with, and it disproportionately affects low income families. In order to better understand the successes and gaps in current care, the Connecticut Children’s Asthma Center led a community collaborative to conduct a federally-funded Asthma Community Needs Assessment.

The 22-member collaborative included physicians, school nurses, pharmacists, community groups, and families impacted by the disease. The collaborative, through this Assessment and a planned clinical trial, is seeking to create a community-wide Asthma Neighborhood to improve outcomes for children with the condition.

The team interviewed 22 experts whose work is touched by asthma; conducted 217 surveys of teachers, principals, school nurses, community organizations, and community health workers; and conducted a survey of 263 Hartford residents. The team also conducted focus groups with primary care clinicians and families impacted by asthma.

While 80 percent of the Hartford families surveyed reported going to an asthma follow-up visit with their child’s primary care physician, Medicaid claims data shows an underutilization of such follow-up care in Hartford. Families cited access to transportation as one reason not to make or keep follow up appointments.

Emergency department and primary care clinicians raised concerns about electronic prescriptions taking up to two hours to reach a pharmacy, which is causing families to leave a pharmacy without a prescription and not return. This is a previously unrecognized gap in getting families to fill prescriptions.

The Assessment uncovered a need to develop a plan to make sure all children have written Asthma Treatment Plans and that those plans are routinely shared between physicians, families, schools and pharmacists.

Parents overwhelmingly expressed satisfaction with the care school nurses and teachers are providing for children with the condition, however the Assessment uncovered opportunities for intervention. Those opportunities include providing more education to teachers about how to recognize symptoms and providing coaches with information on which children are diagnosed with asthma.

The Assessment’s key recommendations include:

• Reducing disparities by identifying children with asthma who are not participating in primary care follow up visits and addressing barriers, such as transportation, that prevent their families from seeking care;
• Developing a written asthma plan for every child with the disease that should be re-assessed on an annual basis and shared with key stakeholders such as schools, families and pharmacists;
• Educating families and physicians about delays pharmacies experience receiving electronic prescriptions and exploring ways to reduce those delays; and
• Providing additional educational opportunities for families, clinicians, school nurses, teachers, coaches, pharmacists and community organizations.

The Connecticut Children’s Asthma Center received a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health to fund this Assessment. The Asthma Center is now applying for a clinical trial to test a new model of care designed to reduce emergency department visits and school absences. It is our hope that the Assessment, and the clinical trial, if approved, will lead to measurable improvements in asthma outcomes for Hartford children.

Michelle Cloutier, MD, is the director of the Connecticut Children’s Asthma Center.

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