A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools

Abstract

Objective

To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma.

Methods

Students 4–14 years old with persistent asthma were enrolled from three SBHCs. The centers’ advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers’ providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care.

Results

We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV₁% predicted and FEV₁/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively).

Conclusions

Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes.

Trial Registration

clinicaltrials.gov Identifier: NCT03032744

Keywords:

• Pediatrics
• prevention
• treatment
• medication adherence
• directly observed therapy
• spirometry
• pulmonary function test
• national guidelines
• health services research
• health disparities
• chronic care model
• children

Declaration of interest

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

Acknowledgements

We would like to thank Sarah Judkiewicz, MSN, Patricia Lindner, DNP, and Anna-Claire Marrone, MD, for their contributions in the early stages of Project ASTHMA. We would also like to thank Lisa Saffire, MD for her assistance in the development of Project ASTHMA’s name.

Additional information

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under award number UL1TR001412 to University at Buffalo. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.