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School-based health centers can help poor children manage their asthma, but they need to follow care guidelines

A growing number of school-based health centers (SBHCs) are providing primary care, including asthma management, to low-income, inner-city children. Many of these children have no other regular source of primary care and end up in the emergency department (ED) with uncontrolled asthma.

A new study of SBHCs in four elementary schools in New York City shows that school care providers do not closely adhere to asthma care guidelines from the National Heart, Lung, and Blood Institute (NHLBI). Creative strategies are needed to care for children with asthma in school settings where parents usually are not present, but where children can be seen for regular followup, suggests Mayris P. Webber, Dr.P.H., of Montefiore Medical Center.

With support from the Agency for Healthcare Research and Quality (HS10136), Dr. Webber and her colleagues analyzed SBHC chart data for 415 children with asthma attending the four schools. NHLBI guidelines recommend that clinicians assess asthma symptoms and peak flow use, monitor medication use, provide asthma education, and monitor exposure to environmental triggers of asthma.

In this study, SBHC staff at the four schools had documented asthma symptoms, peak flow use, followup visits, and referrals to asthma specialists in the charts of 60 percent, 51 percent, 22 percent, and 3 percent of patients, respectively. They documented asthma severity in only one-third of charts; of these, 70 percent of children had appropriate medications prescribed.

Asthma education and an asthma plan were documented in 18 percent and 10 percent of charts, respectively. Environmental asthma triggers and tobacco exposures were documented in 71 percent and 49 percent of charts, respectively. Children older than 8 years were more likely to have chart documentation of peak flow use for asthma management, asthma education, followup visits, and written asthma plans. Younger children were more likely to miss more days of school. Overall, one-third of parents said their child had been to the ED for asthma in the past year.

More details are in "Do school-based health centers provide adequate asthma care?" by Tosan Oruwariye, M.D., M.P.H., M.Sc., Dr. Webber, and Phillip Ozuah, M.D., Ph.D., in the May 2003 Journal of School Health 73(5), pp. 186-190.

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