 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Shawn K. Bowen, MD1, Roy Grant2, Karen M. Drezner, MEd1, and Alan Shapiro, MD3. (1) Division of Community Pediatrics, Childhood Asthma Initiative, The Children's Hospital at Montefiore/AECOM, 317 East 64th Street, New York, NY 10021, 212-535-9779, sbowen@montefiore.org, (2) The Children's Health Fund, 317 East 64th Street, New York, NY 10021, (3) South Bronx Health Center for Children and Families, The Children's Hospital at Montefiore, 871 Prospect Avenue, Bronx, NY 10459
Asthma is the most common chronic pediatric illness, one with serious racial-ethnic disparities. It disproportionately affects poor, minority urban children. Use of the National Heart Lung and Blood Institute (NHLBI) guidelines to inform treatment decisions improves asthma management. The guidelines, however, are long and complex, and there has been documented resistance to their use. This presentation focuses on the modification and application of the NHLBI guidelines in a busy primary care setting with medically underserved inner city children. Data from a comprehensive asthma intervention program (The Children’s Health Fund Childhood Asthma Initiative) are presented. Each patient was assessed, and controller medication prescribed, using the NHLBI guidelines, on first and follow-up visits (average interval, 4 months). Data derived from 589 initial asthma assessments (mean age = 56 months) show a prevalence of moderate- and severe-persistent asthma in this patient population of 56%, with 47% presenting moderate- or severe-persistent night symptoms. Based on retrospective chart review of a subset of 282 patients for whom data from at least one follow-up visit were available (mean age = 52 months), we found the following: At baseline, 82% had persistent asthma; on follow-up this decreased to 65% (p<0.05). Initially 65% were assessed with moderate-severe asthma; this declined to 47% (p<0.05). The percentage of patients with severe night symptoms decreased from 28% initially to 16%, which may be anticipated to result in greater alertness and readiness to learn in school. While we only have relatively short-term follow-up data available at this time, we found that the percentage of patients requiring hospital admission for asthma decreased from 35% had been hospitalized within the past year compared with 2% within the follow-up interval; and the percentage of patients using the emergency room similarly decreased, from 59% to 13%. We are monitoring these trends and anticipate that some full-year follow-up data will be available for presentation. Through implementation of the NHLBI guidelines, we increased use of controller medication for patients with persistent asthma from 30% to 75% (p<.05). Specific recommendations for modification of the NHLBI guidelines to streamline them for use in a busy primary care setting will be made.
Learning Objectives:
Keywords: Asthma, Urban Health Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.