To respond to this need, as Asthma Education Program (AEP) was developed with support of the PCI grant.  The new program was directed by FHCN’s Associate Medical Director who had significant experience with asthma.  She immediately recruited the talents of two nurse case managers and two health educators as well as several members of the Community HealthCorps, FHCN’s AmeriCorps program.  A national expert on asthma was engaged as a consultant to help provide feedback, educational inservice to professional staff, and recommend strategy for change in the management of asthma.

For the past two years an institution wide multi-disciplinary Asthma Task Force (ATF) has met on a monthly basis to recommend policy and direction for the AEP.  The efforts made by the ATF has resulted in acceptance of the National Institute of Health Clinical Guidelines for the diagnosis and treatment of asthma, the establishment of linkages between acute care, ambulatory care and the School Health Program, and the development of inpatient and ambulatory care protocols for the treatment of asthma.

Evidence of Community Need

The AEP gathered statistical data showing the distribution for FHCN patients who are diagnosed with asthma and live in zip codes 11220, 11232, and 11215.  In addition, ten of our twelve School Health Program sites are located within the three zip codes.  In 1993, the network’s asthma patient population within the three zip codes was 1.018.  This number increased in 1994 to 1,201and increased again to 1,401 in 1995, a 38.0% increase in two years.

Target Audience

The AEP team targeted the 0-5 age group since this was the group with the highest apparent need.  AEP initiated a Nurse Case Management (NCM) component in the ambulatory care setting starting at the prevention level to work intensely with the targeted age group.  On the team with the NCM are Health Educators who worked with the general asthma patient and introduced a School Asthma Program component at two of FHCN’s School Health Programs with the support of several members of the Community HealthCorps, FHCN’s AmeriCorps program.  Their role was to provide basic knowledge of the functioning of their lungs and pathogenesis of asthma; show the proper use of peak flow meters, MDI, spacers and nebulizers; and provide a better understanding of the prescribed medications and potential triggers.  The staff provided home visits to reinforce teachings as well as to conduct a home environment assessment with the family.

Two educational models were established:  (1) Community Health Education Program using group sessions held in FHCN satellites and (2) School Asthma Program.

(1)  Community Health Education Program

Initially, a three-session health education program was established.  Attendance was excellent at the first session, but dropped precipitously for the second and third sessions.  Health educators spent an enormous amount of time on the phone trying to encourage clients to attend sessions and initiate new groups.  As a result, a new strategy was developed which focused on the "teachable moment" model.  Afterwards, one-to-one educational sessions were conducted on the same day patients presented to the health center for asthma care.

The advantage of the 1:1 educational session is the ability to instruct patients at an aged and educationally appropriate level for the patient.  This also allowed for a question and answer period to verify patient understanding.  The AEP staff continues to hold group sessions to increase visibility and to reach people who might not otherwise come in contact with the health education staff.  Patient incentives to increase participation include T-shirts, hats, water bottles and even child care.

(2)  School Asthma Program

The School Asthma Program (SAP) was designed to introduce the Asthma Education Program to students who were enrolled in the School Health Program.  P.S. 314 and Dewey JHS participated in this innovative project.

Students were taught how to be aware of their respiratory system and how to avoid and control environmental factors that can trigger an asthma episode.  Students who participate in SAP have the opportunity to practice and demonstrate their skill development on use of peak flow meters, metered dose inhalers and spacers for asthma management.  SAP incorporates decision-making and problem-solving activities into the curriculum to enable both parents and students to acquire the skills needed for appropriate asthma management.  By participating in SAP, students learned the importance of preventive care and its influence on the outcome of asthma.

Program Objectives and Goals

The goal of the AEP was to develop a Network-wide primary care approach to the care of asthma patients.  A second goal for the AEP was the development of a culturally sensitive patient education curriculum to address parental concerns and assist them in developing skills to control their children’s asthma.  Ultimately, the outcome goals are to increase parental knowledge about asthma, decrease utilization of emergency department and walk-in visits, along with decrease admissions related to asthma exacerbations