Working Toward a Sustainable System of Asthma Care: Development of the School-Based Preventive Asthma Care Technology (SB-PACT) Trial

Abstract

Objective. We previously conducted the School-Based Asthma Therapy trial to improve adherence to national asthma guidelines for urban children through directly observed administration of preventive asthma medications in school. The trial successfully improved outcomes among these children; however, several factors limit its potential for dissemination. To enhance sustainability, we subsequently developed a new model of care using web-based guides for efficient communications and integration within school and community systems. This article describes the development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. Method. We developed the SB-PACT web-based system based on stakeholder feedback, and conducted a pilot randomized trial with 100 children to establish its feasibility in facilitating preventive asthma care for high-risk children. The SB-PACT system represents a new model of care using web-based guides for asthma symptom screening, follow-up control assessments, and electronic communications with providers. Result. We enrolled and successfully screened all children using the web-based system. Most providers used the electronic communication system without difficulty, and the majority of children in the intervention group received preventive medications through school as planned and dose adjustments as needed. Several challenges to implementation also were encountered. Conclusions. This program is designed to promote sustainability of school-based asthma care, reduce program costs, and ultimately succeed in a real-world setting. With further refinements, it has the potential to be implemented nationally in schools.

• asthma
• preventive care
• school-based
• sustainability
• technology

Acknowledgements

We thank Andrew MacGowan, Donna Hill, Ph.D., Flora McEntee, R.N., the school nurse program, and the RCSD for their ongoing partnership and support of our work. We would also like to acknowledge SophiTEC for the development of the web-based technology used in this study. Lastly, we thank Elise Wiesenthal for her assistance in preparing this manuscript and the SB-PACT study team for their limitless energy to help children with asthma. This work was funded by a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health (RC1HL099432).

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.