International Conference on Health, Wellness & Society 2013, Sao Paulo, Brazil
- 1. Reference: 1. 2006-2008 SPARCS data. New York State Department of Health 2010 from www.nyhealth. gov/statistics/ny_asthma 2. Krieger, James, Lin Song, Timonthy Takaro, and James Stout. “Asthma and the home environment of low-income urban children: Preliminary findings from the Seattle-King country healthy homes project.”Journal of Urban Health: Bulletin of the New York Academy of Medicine. 77. no. 1 (2000): 50-67. 10.1007/BF02350962 (accessed March 1, 2013). 3. Lwebuga-Makasa, J. Dunn-Georgiou, E. (2002). A School-Based Asthma Intervention Pro gram. Journal of School Health, 72(1) 27-32. 4. Stanton, M.W., Dougherty, D. (2005) Chronic Care for Low-Income Children with Asthma: Strategies for Improvement. Research In Action 2005; AHRQ Pub. No. 05-0073 5. “National Prevention Strategy,” last modified June 11, 2011 HealthCare.gov http://www. healthcare.gov/prevention/nphpphc/strategy/index.html Conclusion: • Home visits are found to be an effective tool for asthmatic children to provide tools to families regarding effective asthma self-management. • Participants in the program were receptive to home visits by nursing students and CHW. • Participants in the program demonstrating increase use of structured medical interventions with support systems in place and decreased use of urgent/emergent services. • Home visits provided to the participants allowed the program to assist participants evaluate their health and environmental habits and create a systematic individualized plan to address issues. • Providing an agency medical letter to landlords to partner with them to address structural issues provided participants support and addressed advocacy needs without jeopardizing current housing. • Participants who were home owners often were not aware of the amount of resources available to assist addressing structural issues at free or reduced cost. • Program provision of advocacy and referral services provided participants a sense that they were being supported in addressing overwhelming issues. Time Lines and Activities 0 50 100 150 200 250 300 350 400 14215 14213 14202 14201 Erie County AverageRate Asthma Rate Erie County Average Asthma Rate Community Based Comprehensive Asthma Management Lauraine A. Neal, RN, MS NEd, ACHNE & Alexis Soto-Colorado, AICP, MUP, MTou D’Youville College School of Nursing, Buffalo, NY Introduction The Asthma Intervention, Resources and Environmental (AIR-E) Management Program was created as a collaboration between the Belle Center (located on the West Side of Buffalo NY) and D’Youville College School of Nursing as a method to collaborate services to reach Asthma affected children ages 0-17 years old and offer: • A systematic plan of screening • Assessment of clients and their home environment • Provision of an Asthma kit, education regarding kit • Re-evaluation of asthma status and environment status on follow-up home visits As the program has evolved it was noted that further management systems would be required. Additional partnerships with the D’Youville College of Pharmacy was created to target education of Asthma affected patients/children in both inpatient and outpatient setting, also partnerships were created with the Buffalo Public schools so that larger populations of children affected with Asthma could be reached. The goals of AIR-E program are to demonstrate the critical steps in creating clinical innovations to address community needs through: • Community assessments, • Provide methods to partner with community agencies to increase the impact of the college/university based programs and • Create methods to track data, improve program operations and achieve program outcomes. Goals • Child’s asthma is under control as shown by no hospitalizations or emergency department visits for asthma in three months • No school absences due to asthma in past month • Child has one specific medical provider for asthma (primary care or specialist) • Child has medical insurance • Child has an Asthma Action Plan completed • Child has appropriate preventive medications and takes them appropriately • Family has reduced indoor asthma triggers • Family has become self reliant in accessing needed supportive services Method and Material D’Youville College School of Nursing Community Home Based Program provided participants with baseline spirometry testing, home assessment of environmental triggers, creation and provision of asthma action plan, asthma journal, and asthma kit, repeat spirometry testing post interventions, referral service for home weatherization/remediation and tenant advocacy if needed. Learning styles utilized for program were, applied learning, use of multiple levels of environments for learning, assessment and incorporation of diverse learning styles and provision of service learning opportunities for nursing and pharmacy students. To determine the population to serve, community assessments were conducted in addition to obtain New York State data to determine zip codes in which the severest cases resided.1,3 Students received extensive training on asthma and home assessments. Students were also partnered with Community Health Workers (CHW’s) to aid in bridging the gap in health care provision and navigation of community Nursing students conducting home assessment as part of the training from the Master Home Enviornmental course from the American Lung Association. Housing condition of vacant home that the students evaluated, multiple triggers noted such as lead, mold, leaky windows. This house is under renovation from the program Heart of the City in Buffalo New York that cre- ates home ownership opportunities to low-income families. Asthma rate according to location in Buffalo, NY. 1 Results • Participants in the program found that they did not have sufficient knowledge regarding indoor air quality and its impact on the asthma affected persons’ health. • Participants were more aware of highly visible asthma triggers such as mold, moisture, mildew, roach/mice droppings but less aware of environmental impact on child’s asthma due to choice of cleaning products, cleaning regimen, and frequency of cleaning. • Participants expressed concern when living in tenant- landlord properties and notifying authorities of living violations. • Many participants felt they would be evicted and because of this issue, chose to continue living in substandard housing that was affordable. • Participants’ caregiver expressed poor use of controller medication because it (the medication) did not provide the same immediate relief of symptoms and often felt like they were “not taking anything at all so why bother taking the (controller) medication.” • Participants expressed difficulty accessing provider for relief from symptoms and quick intervention. They were often told they had to bring child in for an evaluation. Due to work schedule participants often went long periods without seeing provider for asthma intervention and utilized ER when child’s asthma became severe. Asthma Rate prevalence according to zip code in Buffalo New York in comparision to the average in Erie County, NY.1 Hypothesis Asthma Intervention, Resources and Evironmental Management program (AIR-E) used the National Prevention Strategy Framework (NPSF) which was created to shift the nation from a focus on sickness and disease to one based on prevention and wellness. This strategy was developed by the National Prevention, Health Promotion and Public Health Council with input from the Federal Advisory Group Prevention, Health Promotion, and Integrative and Public Health. This group is called “The Strategy” which includes a vision, goal, pillars, priorities and recommendations to help guide the Federal government and the nation on the most effective and achievable means for improving the health of Americans through prevention and health promotion policies and programs. 5 The vision of NPSF promotes organizations to work together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness. Acknowledgment: Master Home Environmentalist & HEAL II Tool: The MHE is a unique program that was developed in 1992 to promote human health by increasing awareness of home environmental pollutants and to encourage actions to reduce exposure. Program results indicate an 87% improvement with individual behaviors.2 The Home EnvironmentalAssessment List – II (HEAL-II) was developed by the Master Home Environmentalist program. Training consists of 100 hours of didactic and field learning and includes instruction on interviewing skills, use of the interview instruments, asthma pathophysiology, and identification and control of asthma triggers. The MHE HEAL II was based on a review of models of determinants of asthma morbidity and a general model of the physical, biological, and social determinants of health. Consultation was received in its development from the NationalAsthma Education and Prevention Program (NAEPP) and Global Initiative forAsthma guidelines, and emphasized inclusion of topics addressed by Healthy Homes protocols.2 Asthma Rate in Buffalo, NY Asthma Rate in Buffalo, NY Colloborating Organizations: RochesterAmerican LungAssociation Community Foundation of Buffalo – Green Healthy Home Initiative Holy Cross Headstart Bethel Headstart Belle Center, Buffalo, NY Buffalo Public School Systems D’Youville School of Pharmacy Community Health Worker Network of Buffalo