Promote Institutional Change for Sustainability
To promote pharmacists' role in asthma patient education, PAA channeled significant attention toward institutionalizing asthma education for these frontline health professionals. PAA saw an opportunity in 2006 with the enactment of the federal Medicare Modernization Act Part D Prescription Drug Program, which resulted in an increased demand for pharmacists to deliver medication therapy to patients. PAA developed an online continuing education program for community pharmacists to impart the knowledge and skills necessary to provide asthma education in a pharmacy setting. By including chronic obstructive pulmonary disease (COPD) in the content, PAA was able to leverage funding from the Minnesota COPD Coalition. Additionally, PAA helped to develop a rotation for fourth-year pharmacy students at the University of Minnesota College of Pharmacy. This five-week program is designed to increase students' knowledge of asthma medications and patient asthma education by providing close proximity to physicians. It also engages the pharmacy students in conducting examinations, performing and interpreting spirometry, charting and participating in home environmental assessments. All rotations offered have been filled and the rotation has been adopted as a regular part of the curriculum, requiring no more funding from PAA.
In 2001, the American Lung Association of Minnesota spearheaded the Controlling Asthma Project which is now called PAA through a grant from the Centers for Disease Control to create the first comprehensive, coordinated strategy for pediatric asthma care in Minneapolis and St. Paul. PAA created a strategic plan that mapped existing asthma care services, identified gaps in care and planned 13 pilot interventions to address the community's needs. Since 2001, PAA has steadily built community capacity to improve asthma control, upgraded and added asthma services and delivery mechanisms to fill the gaps, evaluated and refined their pilot interventions and worked to sustain the program. By implementing a coordinated system of interventions that delivers consistent messages, guidance and assistance on how to best manage pediatric asthma across a network of care, PAA has changed the way asthma is managed in an urban setting.
STRONG COMMUNITY TIES -- ENGAGE YOUR COMMUNITY WHERE THEY LIVE
Choosing a familiar and comfortable location, such as a church or other faith-based site and training a community member to deliver education sessions in the language of choice for that neighborhood are PAA's secrets of success for increasing participation at group parent education sessions.
Ensure Mission-Program Alignment
At its inception, PAA set a bold mission: approach asthma management from every angle; connect doctors, pharmacists, emergency departments (EDs), clinics, health plans, schools, child care centers and families with interventions that employ consistent messages and guidance on how best to manage pediatric asthma. PAA's coalition of 60 leading health, education, public policy and community partners brought the right decision makers to the table from the start. Together, they designed programs that implemented interconnected and overlapping interventions across key sectors to create a community-based network of care. The PAA strategy focused on four broad areas: school-based interventions, health systems/professional education, community-based education and policy initiatives. All of the initiatives focused on improving pediatric asthma outcomes across the community.
PAA joined Minneapolis Public School's existing Healthy Learners Asthma Initiative (HLAI) and broadened the reach of this successful program by funding its implementation in St. Paul Public Schools. A key aspect of HLAI is the Asthma Resource Nurse, who provides training and mentoring for school nurses, supports enhanced asthma care and assists with complex cases. The HLAI model, evaluation findings and sustainability efforts have been featured in several national, peer-reviewed journals, HLAI is also being piloted in rural communities.
INTEGRATED HEALTH CARE SERVICES--FACILITATE COMMUNICATION ACROSS CARE TEAM
PAA invites school nurses, who serve the area around each health clinic, to participate in the clinic quality improvement meetings. As part of the care team, the school nurses share information from their unique perspective and get support to improve asthma care in their school.
Evaluate Program Implementation
The PAA initiative includes multiple interventions, each of which is evaluated to assess whether its design meets its goals. For example, in an effort to tailor asthma care education for frontline health professionals and promote the use of spirometry to diagnose and manage asthma, PAA developed a new training entitled "Implementation and Interpretation of Spirometry in Primary Care." The training is customized and delivered to nurses or clinic staff responsible for administering the test and health providers who interpret test results. Initial evaluation indicates 89% of participants reported they were likely to apply what they learned. The training continues; it is in high demand and fills to capacity each time it is offered.
To assess the program's impact on health outcomes, PAA obtained UB92 claim forms from Minneapolis hospitals and identified aggregate data for pediatric asthma hospitalizations and ED visits where asthma was a primary or secondary diagnosis. Comparing the data from 2000 (one year prior to beginning their work) with the data from 2006 (five years into their program) they found a 48% reduction in pediatric asthma hospitalizations and an 8% reduction in pediatric ED visits. Although there isn't a definitive way to attribute this decline solely to PAA sponsored interventions, the coalition is confident that their efforts are making a significant contribution.