Improving care for minority children with asthma: Professional education in public health clinics

被引:114
作者
Evans, D
Mellins, R
Lobach, K
RamosBonoan, C
PinkettHeller, M
Wiesemann, S
Klein, I
Donahue, C
Burke, D
Levison, M
Levin, B
Zimmerman, B
Clark, N
机构
[1] Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY
[2] Bureau of Child Health, New York City Department of Health, New York, NY
[3] Department of Health Sciences, Jersey City State College, Jersey City, NJ
[4] Med. Hlth. Res. Assoc. New York C., New York, NY
[5] Division of Biostatistics, Columbia University, School of Public Health, New York, NY
[6] Department of Educational Psychology, City Univ. of New York Grad. Center, New York, NY
[7] Dept. Hlth. Behav. and Hlth. Educ., University of Michigan, School of Public Health, Ann Arbor, MI
[8] Pediatric Pulmonary Division, Columbia University, College of Physicians and Surgeons, New York, NY 10032
关键词
asthma; children; minority populations; continuing medical education; patient education; public health; antiinflammatory therapy; spacer devices for inhaled therapy;
D O I
10.1542/peds.99.2.157
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective. Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children. Although effective preventive therapy is available, many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care. To see if access, continuity, and quality of care could be improved in pediatric clinics serving low-income children in New York City, we trained staff in New York City Bureau of Child Health clinics to provide continuing, preventive care for asthma. Methods. We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics. Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management. The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change. We hypothesized that after the intervention, clinics that received the intervention would, compared with control clinics, have increased numbers of children with asthma receiving continuing care in the clinics and increased staff use of new pharmacologic and educational treatment methods. Results. In both the first and second follow-up years, the intervention clinics had greater positive changes than control clinics on measures of access, continuity, and quality of care. For second year follow-up data these include: for access, greater rate of new asthma patients (40/1000 vs 16/1000; P < .01); for continuity, greater percentage of asthma patients returning for treatment 2 years in a row (42% vs 12%; P < .001) and greater annual frequency of scheduled visits for asthma per patient (1.85 vs .88; P < .001); and for quality, greater percentage of patients receiving inhaled beta agonists (52% vs 15%; P < .001) and inhaled antiinflammatory drugs (25% vs 2%; P < .001), and greater percentages of parents who reported receiving patient education on 12 topics from Bureau of Child Health physicians (71% vs 58%; P < .01) and nurses (61% vs 44%; P < .05). Conclusion. We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.
引用
收藏
页码:157 / 164
页数:8
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