Reforming pediatric asthma services to improve access, education and care

The burden of pediatric asthma in the U.S. is serious and growing for children, families and communities. Unnecessary utilization of Emergency Departments (ED) and hospitalizations illustrate the relative lack of effective programs and services for this disease. A study was recently conducted to examine parents' perceptions of access to basic care and ED use for asthma management. A sample of 50 parents and guardians of children with asthma (aged 2-18 years) who were admitted to the ED at a major children's hospital in the Southeastern U.S., were interviewed between March and August 2009. Each family underwent a semi-structured interview using a modified Barriers to Care Questionnaire. It was found that only 7% of the parents and guardians were using an Asthma Management Plan and/or had a thorough understanding of triggers, preventive strategies and use of medications to manage asthma symptoms. Nearly 50% also reported difficulties in obtaining asthma medications due to high cost and/or inadequate insurance coverage. Health administrators need to restructure their organizations to more effectively address these access and educational deficiencies. Hospital/health systems need to develop special multidisciplinary committees to advocate for and support improved pediatric asthma care; standardize patient education care and resources, including the establishment of better Asthma Management Plans; and establish pediatric asthma clinics with the personnel and resources to provide better care and education. Hospital/health systems also must establish effective community partnerships with primary care providers, and collaborate in developing specific evidence-based intervention strategies with measurable outcomes that address pediatric asthma education and care needs and inequities at the local level.