Looking Beyond The Symptoms: Treating Children With Asthma In The Inner-City

WASHINGTON, D.C.  When it comes to treating children with asthma in the inner-city, practical steps that address the everyday challenges urban families face are the key to improving health, according to the results of a four-year project administered by the Alliance of Community Health Plans (ACHP) through a contract with the Centers for Disease Control and Prevention (CDC).

The project, Inner-City Asthma Intervention, was a follow-up to The National Cooperative Inner-City Asthma Study, which was the largest U.S.-based initiative to emphasize comprehensive asthma interventions, environmental risk-factors, medication adherence and education.  The Inner-City Asthma Intervention tested these comprehensive interventions in urban community settings.

It included more than 4,000 children in over twenty cities across the nation, including Washington, D.C.; Kansas City, Missouri; Chicago; New York; Baltimore; Birmingham; Los Angeles; and Dallas.  Children participated in year-long interventions that provided allergy testing, a needs-assessment of the family and child, an asthma care plan developed with the family, and education and counseling sessions.

Few asthma interventions make it from the research setting to the real world, and those that do frequently fail to address the unique and often interconnected needs of urban families.  The Inner-City Asthma Intervention found that, while challenging, implementing an asthma management program in the inner-city is achievable.  

The project targeted a web of risk factors that contribute to poor asthma control in the inner-city, including: second-hand smoke and other environmental pollutants; language barriers; transportation barriers; mental health issues of the family; poor medication management; and lack of access to high-quality and affordable medical care, among a host of other challenges that complicate life for families living in inner-cities.

Results from theKansas Cityprogram site showed increases in children using controller medications and families having asthma care plans, as well as lower average hospital admissions rates.  While the 22 program sites experienced varying degrees of success, the overall effort represents an important step forward in improving management of asthma among children in inner-cities, where rates of asthma hospitalization and mortality are disproportionately high.

Given the challenges it faced, the Inner-City Asthma Intervention was “a very successful first step in a process for which we have little or no evidence or experience to guide us – the real-world implementation of an asthma program in poor, disadvantaged populations,” according to Meyer Kattan, M.D. of Mount Sinai School of Medicine in New York City, which hosted two program sites.

Findings include:

  • The project supported the addition of a master’s degree level social worker to the care management team.  Collaboration between the social worker and a health care professional allowed the intervention to address critical needs beyond the child’s asthma that pose barriers to improving health, such as the psychological needs of the family and a connection to the local social welfare system.
  • Counseling and education sessions were better attended when conducted at times families and children were most readily able to participate, typically after work, school half-days and weekends.  The flexibility of the asthma counselor’s schedule was vital to this effort.  Refreshments at sessions held during mealtimes increased the incentive and enjoyment of families attending, as well as helped counselors deliver messages to a more receptive audience.
  • While this project depended largely upon federal funds, it showed that sustainability with private funds is possible when the value of the project is clearly demonstrated to the community.  Successful projects require collaboration with community stakeholders, identification of suitable interventions, adaptation to community needs, continuous evaluation of the intervention and demonstration of its effectiveness to stakeholders.

Information about these and other lessons learned from the Inner-City Asthma Intervention is detailed in a supplement to the July 2006 issue of the Annals of Allergy, Asthma and Immunology.

More information about the Inner-City Asthma Intervention is available in ACHP’s asthma tool kit: Alleviate Asthma! Cultivating a Successful Pediatric Asthma Initiative.

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About ACHP

ACHP is a leadership organization that brings together innovative health plans and provider organizations that are among America’s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate to share strategies and work toward solutions to some of health cares biggest challenges. Their work is the foundation for ACHPs advocacy on behalf of better health care nationally.  More information is available at www.achp.org.