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APHA Scientific Session and Event Listing

Recorded presentation

John Wiecha, MD, MPH, Distance Education for Health, Department of Family Medicine, Boston Medical Center, Dowling 5 South, Boston Medical Center, 1 BMC Place, Boston, MA 02118, 617 414 4465, john.wiecha@bmc.org and William G. Adams, MD, Department of Pediatrics, Boston Medical Center, Boston Medical Center, 1 BMC Place, Boston, MA 02118.

To achieve modern and effective management of patients with chronic disease in the primary care setting requires a reengineering of health care systems and relationships to create interdisciplinary teams of professionals providing evidence-based patient-centered care.

Asthma has long been recognized as the most common chronic disease of childhood. It has become increasingly prevalent and severe in recent decades despite effective medical therapy. In urban areas and among the disadvantaged, these trends are particularly marked.

Research data illustrate that proper use of effective medications, environmental control interventions, teamwork among health care professionals, and patient education for self-management each independently, and even more powerfully when employed in combination, can reduce asthma morbidity and associated health care costs.

This presentation will describe a new method of promoting each of these factors to achieve improved outcomes.

The BostonBreathes (BB) system uses a sophisticated interactive clinical website to permit physician-to-physician and physician-patient communication, monitoring (peakflow, medication use, symptoms) of asthma patients in the home, and patient and family asthma education. The system helps primary care physicians to function in team relationships with asthma specialists and nurses. Patients and families have the opportunity to interact with their health professionals online as integral members of the care team.

Using a randomized clinical trial design, this project is testing the hypothesis that the BB website will improve patient knowledge and medication adherence, and teamwork among individuals caring for pediatric asthma patients, resulting in improved quality in the process and outcomes of asthma care. The team approach used in BB will be adaptable to many other chronic diseases managed by health care providers working in diverse primary care delivery systems.

This presentation will describe the theoretical and proven benefits of clinical teamwork in chronic disease care, the barriers to improving quality of care of pediatric asthma, and the design of the patient and health care providers websites that are BB, the educational content and processes, the clinical teamwork processes, and preliminary evaluation outcomes including utilization, patient and provider feedback, and impact on asthma outcomes including adherence to medication, symptoms, and quality of life. This research and development is supported by The Commonwealth Fund, NYC.

Learning Objectives:

• Describe barriers to improving pediatic asthma outcomes.
• Describe the research findings on teamwork among health care providers caring for patients with chronic illness.
• Describe the theory, design, and findings of an approach to improving asthma care which uses a web-based system to educate and monitor patients, to communicate with health care providers, and to facilitate clinical teamwork.

Keywords: Asthma, Telemedicine

Related Web page: www.bu.edu/fammed/bostonbreathes/Info.htm

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation