Transcript Asthma: Shared Medical Appointments

Asthma:
Shared Medical Appointments
Dr. Jill Batson

Asthma is a chronic lung disease that affects the
lungs in two ways; by narrowing of the airways in
bronchospasm and with inflammation and mucous
production.
http://www.nhlbi.nih.gov/health/healthtopics/topics/asthma/







Asthma is one of the most common
childhood illnesses seen by health care
professionals
2011 & 2010 US statistics
Number of children who currently have asthma: 7.1 million
Percent of children who currently have asthma: 9.5%
Number of visits to physician offices with asthma as primary diagnosis: 14.2 million
Number of visits to emergency departments with asthma as primary diagnosis: 1.8 million
Number of deaths: 3,404
http://www.cdc.gov/nchs/fastats/asthma.htm
In Texas in 2009 there were 538,000 children (8.2%) and 1.2 million adults
(6.5%) who had a current diagnosis of asthma.
 That year there also 28,000 hospitalizations reported for asthma for all age
groups in Texas
 This burden of disease comes at a steep price. In 2010, Texas Medicaid
reimbursements for professional, outpatient and inpatient hospital claims for
asthma were approximately $60.5 million

http://www.dshs.state.tx.us/asthma/reports.shtm






Parkland Health & Hospital System is Dallas County’s public hospital and is the
primary care provider for many low income patients.
Parkland consists of a hospital facility and a network of community-based
(COPC)and school-based clinics.
In 2003 the COPC administration convened an asthma force that included
health care professionals and community organizations.
The group decision made the decision to use SMA’s (Shared Medical
Appointment) to help address the problem of childhood asthma
PHHS partnered with DISD
SMA’s began in 2005-06 school year, initially in the 75217 zip code. This area
was determined by the task force to have the greatest need
SMA
team
DISD
Family
• MD, Nurse, Educator
and business staff
•PHHS and CMC
•School Nurse
•Administrators
•Smoking Cessation
•Asthma education
Shared Medical Appointments
Shared Medical Appointments are typically scheduled on a monthly
basis.
 School Nurse identifies patients appropriate for program
 Screening questionnaires have been also been used in the past
 Patients without primary care providers may be referred to Youth
and Family centers

Shared Medical Appointments






SMAs occur on site at school at the end of day
Held in Library or Multipurpose room
Health educator provides interactive asthma information to students and
parents
Nurse performs screening and vital signs
Health care provider provides exam and medication.
Family and the school nurse have access to team for questions by phone or
through Youth and Family centers between site visits
Shared Medical Appointments
At initial visit patients are given Spacer, Peak Flow Meter and
Asthma Action Plan
Physician follows standardized guidelines recommended by the NHLBI (The
National Heart, Lung, and Blood Institute) for the Diagnosis and Management
of Asthma. NHLBI provides protocols in the treatment of diseases such as
asthma.
 Health educator follows a standardized curriculum- including “What is
Asthma, Asthma Action Plans”

Shared Medical Appointments
In 2011-12 the SMAs served 14 DISD schools, registered 168 students
and had and average of 5 students per visit
 In 2012-13 the SMAs served 12 schools, registered 153 students and
served an average of 6 student per site visit
 Many of the students seen at the SMA who did not have a primary
care doctor were referred on to PHHS Youth and Family centers
where the continue to follow for comprehensive care after SMA was
completed

Shared Medical Appointments

Over the last 6 years the Shared Medical visits have successfully seen
a reduction in the need for outside medical interactions for asthma
as well as an improvement in many quality of life factors including

ER visits
Missed days of school
Night time awakenings for cough
Daily rescue inhaler use




Most patient showed improvement in their understanding of
rescue vs. controller medicine as well asthma action plan and
spacer use
Shared Medical Appointments
The SMA team maintains ties to well established schools while engaging new
schools where a significant need exists
 They continue improve on the curriculum and communicate in a manner that
facilitates learning in English and Spanish to reach parents and students.
 Improved understanding about the disease process and regular medical
care will help more Texas children with Asthma live healthy and active lives

Shared Medical Appointment

Questions