(Chest. 1999;116:201S-202S.)
© 1999
American College of Chest Physicians
The Lawndale Christian Health Center Asthma Education Program*
Florence Roque;
Loretta Walker;
Pat Herrod;
Toni Pyzik and
William Clapp, MD
*
From the Lawndale Christian Health Center, Chicago, IL. Supported by a grant from the Otho S.A. Sprague Memorial Institute.
Correspondence to: William Clapp, MD, Lawndale Christian Health Center, 3860 W Ogden Ave, Chicago, IL 60623
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Introduction
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The
National Asthma Education Prevention Program Expert Panel Report 2
guidelines describe four components necessary for an effective asthma
management program. The fourth component emphasizes that "education
for active partnership with patients remains the cornerstone of asthma
management."1
Lawndale Christian Health Center (LCHC)
has developed an asthma education program that emphasizes the
importance of developing trusting relationships leading to partnerships
that can result in effective education.
LCHC was founded in 1984 as a ministry of Lawndale Community
Church, for the purpose of demonstrating God's love by providing
high-quality, affordable health care to the medically underserved
Lawndale community of Chicago, IL. In 1990, LCHC became a Federally
Qualified Heath Center and was designated as a 330 Health Care Site in
1992. The patient volume has grown from 4,000 patient visits in 1984 to
> 65,000 in 1997.
Two asthma educators coordinate the asthma education program.
They both live in neighborhoods serviced by the clinic, and were
originally hired as support staff. They have received training in
asthma and asthma management, have personal experience with asthma,
and, very importantly, bring substantial relational expertise to
the position.
The LCHC asthma program has three major components: (1) a weekly asthma
clinic; (2) home visits; and (3) asthma seminars.
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Weekly Asthma Clinic
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Patients with asthma are scheduled for regular follow-up
visits during a weekly asthma clinic. In order to emphasize the
importance of regular visits and improve attendance, the asthma
educators contact the patients beforehand to remind them of their
clinic appointments. At the clinic visit, the asthma educator takes a
history using a standardized form designed to elicit details about
asthma severity, triggers, and exposures. After a focused physical
examination by a pulmonary physician (for adults) or a pediatric nurse
practitioner (for children), the asthma educator reviews topics
tailored to the patient's needs. These topics include basic
respiratory anatomy and physiology; basic asthma pathophysiology;
triggers and trigger control; purpose and administration of
medications; use of metered-dose inhalers and spacers; use of
nebulizers; and use of peak flowmeters. The patient leaves with an
information packet and customized printed instructions, including an
action plan. The instructions include names and contact numbers of the
health-care providers and a pager that patients can call if they run
out of medicines or need help during off hours. When the patient
returns to the clinic, this information is reviewed and, if necessary,
reinforced.
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Home Visits
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Often patients find it difficult to come in for their
scheduled office visits.2
In such situations, the asthma
educators make home visits. This is particularly helpful for caregivers
with many children, ill patients who have recently been discharged from
the hospital, patients for whom repeated reinforcement of the
educational messages is particularly important,2
and for
patients who can't seem to make it into the clinic for other reasons.
The home visit also provides an opportunity for the asthma educator to
conduct an environmental assessment. Most importantly, home visits help
patients feel that they have a caring resource that is helpful and
accessible, which contributes to a relationship of trust.
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Asthma Seminars
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In the third component of the program, half-day asthma
seminars are presented to patients, their families, and other people
with asthma in the neighborhood. Speakers have included LCHC asthma
educators, respiratory therapists, an expert on nontoxic cockroach
control, outreach workers, and a nurse from LCHC. Stories and
experiences have been shared by members of the community and discussion
has been led by the Chicago Health Connection, a group that is
interested in developing community-based support networks. The seminars
are festive events, with meals, incentives, and door prizes for the
participants. In addition to disseminating knowledge about asthma, the
seminars also encourage the development of supportive relationships
among asthma patients, their families, and other people with asthma in
the community.
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Impact Study
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To evaluate the impact of the asthma education program, a
questionnaire was administered to adults that addressed asthma-related
absenteeism, emergency room visits, and hospitalization. The Scale for
Measurement of Quality of Life in Adults with Asthma3
was
also included. The questionnaires were administered at the first asthma
clinic visit and repeated at 3 months or later. Significant
improvements were found for a number of the quality-of-life questions
(data not shown). Asthma morbidity also improved, with fewer patients
requiring hospitalization or emergency care in the 4 weeks prior to the
second questionnaire (Fig 1
).
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Figure 1. Responses to question, "Has asthma resulted in
any of these occurrences in the prior 4 weeks?" Data represent number
of patients who replied "yes" (n = 30). ER = emergency room;
Wrk = work; Schl = school.
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Discussion
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For many reasons, health education is difficult in medically
underserved urban communities. Many patients have a history of bad
experiences with the health-care system,4
resulting in a
reluctance to develop true partnership with any health-care provider.
Moreover, many people with asthma have had such negative educational
experiences in the past that they are resistant to formalized
educational efforts. These issues can make educational clinic
appointments uncomfortable, and make routine follow-up difficult for
many patients. LCHC has found that to develop the foundation of
trust necessary for partnership and education, a highly personalized,
one-on-one approach is important.
The asthma educators fulfill a role that is in many ways similar
to a case manager. Because the educators are from the community, they
are viewed as respected peers and are thus able to communicate and
reinforce the elements of asthma care with greater efficacy than a
provider of a different educational and cultural background.
Importantly, concern for the emotional and spiritual well-being of the
person with asthma significantly enhances the asthma educator's
credibility. Furthermore, the asthma educators frequently elicit
critical information about a person's environment and habits that many
physicians or nurse practitioners would have difficulty obtaining. This
can lead to referral to address issues such as substance abuse,
domestic violence, or unfit housing. Indoor air quality remains one of
the most difficult aspects to improve; while a number of approaches may
be very helpful, some patients may require relocation.
Although third-party payers are reluctant to expend resources on
these sorts of preventive measures, this highly personalized approach
is helpful in reducing morbidity. Hopefully, this will be shown to be
financially worthwhile and therefore sustainable. Until such time, such
programs will require funding from other sources.
In summary, medically underserved communities have motivated,
capable people who can help bridge the distance between a dauntingly
complex and somewhat indifferent health-care system and appropriately
skeptical members of the community.4
With their guidance,
trusting relationships can be built to allow development of an
essential partnership for effective asthma education.
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Footnotes
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Abbreviation: LCHC = Lawndale Christian Health Center
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References
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National Asthma Education and Prevention Program. Expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health, April 1997; Publication No. 97–4051
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Evans, R (1992) Asthma among minority children: a growing problem. Chest 101(suppl),368S-371S[Free Full Text]
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Marks, GB, Dunn, SM, Woolcock, AJ (1992) A scale for measurement of quality of life in adults with asthma. J Clin Epidemiol 45,461-472[CrossRef][ISI][Medline]
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Abraham, LK (1993) Mama might be better off dead: the failure of health care in urban America. University of Chicago Press Chicago, IL.
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TOP
Introduction
Weekly Asthma Clinic
