Asthma: Shared Medical Appointments

1. Asthma:Shared Medical Appointments Dr. Jill Batson

2. Asthma is a chronic lung disease that affects the lungs in two ways; by narrowing of the airways in bronchospasm and with inflammation and mucous production. http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/

3. Asthma is one of the most common childhood illnesses seen by health care professionals • 2011 & 2010 US statistics • Number of children who currently have asthma: 7.1 million • Percent of children who currently have asthma: 9.5% • Number of visits to physician offices with asthma as primary diagnosis: 14.2 million • Number of visits to emergency departments with asthma as primary diagnosis: 1.8 million • Number of deaths: 3,404 http://www.cdc.gov/nchs/fastats/asthma.htm

4. In Texas in 2009 there were 538,000 children (8.2%) and 1.2 million adults (6.5%) who had a current diagnosis of asthma. • That year there also 28,000 hospitalizations reported for asthma for all age groups in Texas • This burden of disease comes at a steep price. In 2010, Texas Medicaid reimbursements for professional, outpatient and inpatient hospital claims for asthma were approximately $60.5 million http://www.dshs.state.tx.us/asthma/reports.shtm

5. Parkland Health & Hospital System is Dallas County’s public hospital and is the primary care provider for many low income patients. • Parkland consists of a hospital facility and a network of community-based (COPC)and school-based clinics. • In 2003 the COPC administration convened an asthma force that included health care professionals and community organizations. • The group decision made the decision to use SMA’s (Shared Medical Appointment) to help address the problem of childhood asthma • PHHS partnered with DISD • SMA’s began in 2005-06 school year, initially in the 75217 zip code. This area was determined by the task force to have the greatest need

6. Shared Medical Appointments

7. Shared Medical Appointments are typically scheduled on a monthly basis. • School Nurse identifies patients appropriate for program • Screening questionnaires have been also been used in the past • Patients without primary care providers may be referred to Youth and Family centers Shared Medical Appointments

8. SMAs occur on site at school at the end of day • Held in Library or Multipurpose room • Health educator provides interactive asthma information to students and parents • Nurse performs screening and vital signs • Health care provider provides exam and medication. • Family and the school nurse have access to team for questions by phone or through Youth and Family centers between site visits Shared Medical Appointments

9. At initial visit patients are given Spacer, Peak Flow Meter and Asthma Action Plan • Physician follows standardized guidelines recommended by theNHLBI(The National Heart, Lung, and Blood Institute) for the Diagnosis and Management of Asthma.NHLBI provides protocols in the treatment of diseases such as asthma. • Health educator follows a standardized curriculum- including “What is Asthma, Asthma Action Plans” Shared Medical Appointments

10. In 2011-12 the SMAs served 14 DISD schools, registered 168 students and had and average of 5 students per visit • In 2012-13 the SMAs served 12 schools, registered 153 students and served an average of 6 student per site visit • Many of the students seen at the SMA who did not have a primary care doctor were referred onto PHHS Youth and Family centers where the continue to follow for comprehensive care after SMA was completed Shared Medical Appointments

11. Over the last 6 years the Shared Medical visits have successfully seen a reduction in the need for outside medical interactions for asthma as well as an improvement in many quality of life factors including • ER visits • Missed days of school • Night time awakenings for cough • Daily rescue inhaler use • Most patient showed improvement in their understanding of rescue vs. controller medicine as well asthma action plan and spacer use Shared Medical Appointments

12. The SMA team maintains ties to well established schools while engaging new schools where a significant need exists • They continue improve on the curriculum and communicate in a manner that facilitates learning in English and Spanish to reach parents and students. • Improved understanding about the disease process and regular medical care will help more Texas children with Asthma live healthy and active lives Shared Medical Appointment

13. Questions