Transcript Title

Integrated Multi-Level Approaches
to Asthma Management
Noreen M. Clark, Ph.D.
Dean & Marshall H. Becker Professor
University of Michigan School of Public Health
Director, Allies Against Asthma
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Asthma Continues as a
Major Public Health Problem
• In 1997, 27 million people reported at some time of
their life being diagnosed with asthma.
• Asthma affects 5% to 10% of children under 18
years of age; is most common reason for childhood
hospitalizations.
• Asthma-associated work absence days have
increased NHIS 50% since 1980 to (14 million in
1996).
• In 1990, cost of illness related to asthma $6.2 billion,
($1.6 for inpatient hospital services alone).
(Mannino et al, 2002)
(Weiss et al, 1992)
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MODERN PARADOX (1)
• Understanding of the pathogenesis
and treatment of asthma has
increased
• Morbidity and mortality from asthma
have increased worldwide
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MODERN PARADOX (2)
• Understanding of the steps that can
be taken to prevent severe asthma
has increased
• Emergency visits and hospitalizations
for asthma have increased worldwide
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Some Logical Conclusions
• Patients and families are not managing
asthma effectively
• Clinicians are either not providing state of the
art care, or, if they are, patients are not
adhering to the recommended programs
• The systems in which patients receive and
health professionals provide services and
education do not foster effective asthma
management
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Recognized Deficiencies in
Health Care Systems
• irregular or incomplete assessment or
inadequate follow-up
• inadequate or inconsistent patient education
and feedback
• omission of effective interventions or use of
ineffective ones
• failing to detect or inadequately manage a
patient’s psychosocial distress
(Wagner 1996a, 21)
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Lack of Attention to
Environmental Factors
• Environmental tobacco smoke (ETS) is
associated with the development of
asthma.
• ETS, cat, cockroach, dust mite are
associated with the exacerbation of
asthma in sensitive individuals.
Institute of Medicine, National Academy of Sciences. 2000. Executive Summary. Clearing the
Air: Asthma and Indoor Air Exposures. Washington, DC: National Academy Press.
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Inadequate Insurance Coverage
• Type of health care visits covered
• Preventive services covered
• Devices and equipment covered
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Asthma is a very variable disease
and an individual must exercise a
significant degree of judgment
regarding management.
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Until we can prevent asthma as a
disease, or develop a cure, success in
control rests on
•Removing systemic barriers to
effective management
•Positioning individuals to be the best
possible manager of the condition
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When stakeholders in asthma
control come together to develop
community wide solutions, the
patient’s efforts to manage must
be at the center of their strategies.
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Management by
Patient
Family Involvement
Clinical Expertise
Work/School Support
Community Awareness, Support & Action
Community-Wide Environmental Control Measures
Conducive Policies
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Intended outcomes of multi level
approaches to asthma control:
• Patients experience no or few symptoms
• Patients are fully functioning
• Morbidity decreases
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Creating optimum opportunity for
management and prevention of
asthma symptoms depends on
coordination among stakeholding
individuals, organizations, and
systems.
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What should be the goal of
community-wide coordination?
• Individuals with asthma: access to continuous
and consistent health care as well as ongoing
information and support from providers, schools,
employers and family
• Health providers: standardized clinical care
(including documentation) and links with external
resources (schools, community) providing support
and education for patients.
• Health plans/insurers: Support for proven
interventions to achieve uniformity in asthma
management and appropriate health service use.
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• Schools/School Nurses/Child Care Providers:
Ongoing Asthma education, communication with
families, supportive care coordination with clinical
providers, attention to indoor environmental issues.
• Public Health Agencies: Availability of
comprehensive data, strategic planning,
formulating enabling policies, and coordination of
efforts.
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Reaching these goals depends on
communication and integration of
efforts across the sectors, and
systems essential to asthma
control.
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State and local health
departments can be primary
facilitators of integration.
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For example:
Michigan state-wide action plan for asthma
• engaged in an inclusive planning process
• involves 125 representatives from public and
private agencies and organizations
• utilizes work groups that cross sectors
•
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Clinical Care
Education
Environmental Quality
Surveillance & Epidemiology
• recognizes and supports coalitions as the “engine”
for integration
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Michigan Asthma Strategic
Planning Task Force
• Provides support for coalitions including financial and
technical assistance, networking, visibility.
• Provides a structure for asthma champions from local
communities to share information, identify and
respond to changing priorities, and explore strategies
feasible for their communities.
• Coordinates internal public health and external
resources to address asthma priorities.
• Utilizes interdisciplinary teams (epidemiology, public
health, environmental control, health education,
health services, etc.) to plan and implement asthma
solutions.
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The key is integration. How to
achieve it will differ by community.
Coalitions may be key in the
process.
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Coalitions can enhance coordination
and integration because by
definition they cross sectors and
systems.
Over 200 asthma coalitions in the
US. At least 20 in the midst of
careful evaluation of collaborative
processes and health outcomes.
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Allies Against Asthma
Resource Bank
…a searchable on-line collection of resources including:
• Asthma related educational materials
• Asthma program resources
• Asthma-related evaluation/survey instruments
• Coalition-related materials
Provides information about tools and resources and
contact information to access.
www.asthma.umich.edu/resourcebank
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An integrated approach to
asthma control could create
procedures and linkages that
enhance community capacity to
manage other health problems.
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Allies Against Asthma
A national program supported by the Robert Wood Johnson
Foundation with direction and technical assistance provided by
the University of Michigan, School of Public Health
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