School-supervised Asthma Therapy is Associated with Improved Long-Term Asthma Outcomes for Underrepresented Minority Children
AuthorsShillan, Holly N.
Luther, Janki P.
Ryan, Grace W
Spano, Michelle A.
Lessard, Darleen M.
Gerald, Lynn B.
Goldberg, Robert J.
Trivedi, Michelle K.
UMass Chan AffiliationsUMass Worcester Prevention Research Center
Division of Pulmonary Medicine, Department of Pediatrics
Department of Medicine
Department of Population and Quantitative Health Sciences
School of Medicine
Keywordsasthma emergency department visits
asthma hospital admissions
school-supervised asthma therapy
underrepresented minority children
Community Health and Preventive Medicine
Respiratory Tract Diseases
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AbstractAsthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values < 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.
Shillan HN, Luther JP, Ryan GW, Hoque S, Spano MA, Lessard DM, Gerald LB, Pbert L, Phipatanakul W, Goldberg RJ, Trivedi MK. School-supervised Asthma Therapy is Associated with Improved Long-Term Asthma Outcomes for Underrepresented Minority Children. J Sch Nurs. 2022 May 12:10598405221100470. doi: 10.1177/10598405221100470. Epub ahead of print. PMID: 35548948. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/44665
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School Nurse Perspectives on the Barriers and Facilitators to School-Supervised Asthma TherapyHoque, Shushmita (2020-04-30)Background: Asthma Link is a program that aims to increase adherence to inhaled corticosteroids among children with persistent asthma by delivering evidence-based school-supervised therapy. This program, which leverages existing infrastructure, improves asthma outcomes in children from low-income, minority families. Our aim was to elicit the perspectives of school nurses who supervise preventive medication administration. Methods: Semi-structured qualitative interviews were conducted with 12 school nurses participating in Asthma Link. Thematic analysis was used to identify themes related to barriers and facilitators to preventive medication delivery. Results: Barriers described by school nurses included communication challenges with families and providers, inconsistent supplies of the preventive medicine at school, and the perception by some families and nurses that preventive therapy should be provided at home. Facilitators included the ease of incorporating preventive medication delivery into morning routines, recognizing the positive impacts on children from families with limited resources, feeling part of the preventive health care team, and being well-positioned to engage families in preventive asthma care. Conclusions: To facilitate Asthma Link adoption, it is critical to incorporate school nurse feedback in the program’s protocol refinement. School-supervised asthma therapy programs are advised to engage school nurses in the opportunity to provide preventive care, streamline communication, and address social and logistical challenges which may impede families from bringing medication to school.
School Nurse Perspectives on School-Supervised Asthma Therapy: A Qualitative StudyHoque, Shushmita; Luther, Janki; Mizrahi, Raphael; Gerald, Lynn B.; Phipatanakul, Wanda; Lemon, Stephenie C.; Rosal, Milagros C.; Byatt, Nancy; Pbert, Lori; Trivedi, Michelle K. (2022-06-16)Background: School-supervised asthma therapy improves asthma outcomes for children, yet this strategy is not widely utilized. School nurses play a vital role in this intervention, yet their perspectives on school-supervised asthma therapy have not been thoroughly examined. Objectives: To examine the perspectives of school nurses participating in school-supervised asthma therapy and identify key facilitators, barriers, and proposed solutions that will facilitate the uptake of this strategy. Methods: We used purposeful sampling to recruit 12 school nurses participating in Asthma Link, a real-world application of school-supervised asthma therapy, between 2017 and 2019. We performed semistructured interviews with school nurses to elicit their perspectives on the facilitators, barriers, and proposed solutions to barriers to Asthma Link implementation. Interview transcripts were analyzed using qualitative descriptive methodology to identify major themes. Results: School nurses identified facilitators for Asthma Link adoption, including the ease of integrating supervised therapy into school nurse routines, recognition of benefits for families with limited resources, and satisfaction participating in preventive care. School nurses identified barriers, including communication challenges with families and providers, families not reliably bringing medication to school, limited nursing staff in schools, and increased school nurse turnover. School nurses proposed specific solutions to these barriers, including appointing Asthma Link liaisons within pediatric practices, incentivizing families to bring medicine to school, and partnering new school nurses with those experienced in delivering Asthma Link to overcome staffing issues and promote program fidelity. Conclusions: School nurse perspectives on the facilitators, barriers, and solutions to barriers are important for understanding how to promote real-world implementation of school-supervised asthma therapy. The themes identified in this study will be utilized to refine our protocol for Asthma Link to facilitate real-world adoption of this evidence-based strategy.
School Based Pediatric Asthma Surveillance in MassachusettsMedaglia, Frances; Abille, Vannalyn (2017-03-03)Asthma remains one of the most common chronic diseases among children in the United States today. Surveillance is limited to national and state estimates which can vary over time and by population (CDC/NCHS, National Health Interview Survey, 2012). It is estimated that anywhere from 14% to 50% of children with asthma remain undiagnosed. The Massachusetts Department of Public Health's Bureau of Environmental Health (MDPH/BEH) has been conducting a successful and comprehensive statewide school-based asthma surveillance program since 2002. Partnering with school nurses throughout the state, we request aggregate information via a one-page survey. The survey is distributed to all public, private, charter and virtual schools in Massachusetts (n=1800). Variables collected include number of students with asthma by gender, grade (K-8), race/ethnicity and community of residence. Therefore, we can estimate prevalence by school and community. Now entering the 15th year, the program has a near 100% survey response rate. This successful surveillance effort reveals a statewide asthma prevalence of 12.4%, one of the highest rates in the nation and suggests approximately 85,000 students in Massachusetts carry the diagnosis. Furthermore, trends over the last 10 years of data collection indicate asthma to be higher among males than females for this age group (~5-14). School-based pediatric asthma surveillance demonstrates the important role school nurses play in surveillance. The feasibility of using school health records as a secondary data source will be highlighted as a reliable, aggregate, community-based source of data.