Vol. 10 •Issue 7 • Page 14
Planning an Asthma Center
Program Promotes Patient Self-management and Education
By Lynn Wattles, ASRRT
When a physician diagnosed two of my three children with asthma as toddlers, I sought education on how to manage and control this chronic disease before another acute situation occurred. Although as a health care professional I could recognize asthma’s warning signs and knew how to treat exacerbations, I nevertheless needed support from someone else who had the same problem.
I discovered the need for an intermediate place–somewhere in between the physician’s office and the emergency room–where asthma patients could go. And I realized that I was probably not alone in my quest. Jupiter Medical Center’s statistics showed that 43 percent of emergency room visits were respiratory and asthma related over a one- to two-year period of time.
After almost two years of research, I took the leap and began developing an asthma education and management program directly affiliated with Jupiter Medical Center, Jupiter, Fla.
PROGRAM FEATURES
My vision was to start an asthma center, not an asthma clinic. The difference is once the physician makes a diagnosis of either asthma or reactive airways disease, he or she writes a prescription for the program and refers the patient to me.
The program is based on four one-on-one interactive sessions, along with group meetings and monthly lectures by a physician. The one-on-one sessions are valuable reinforcement tools, especially a few days following an ER visit. When a patient is having problems breathing, it’s extremely frightening for him and for the caregiver. In addition, the patient has difficulty listening and remembering everything the clinician tells him. Repeating this information when the patient is calm supports the learning process.
The sessions concentrate on proper breathing techniques, demonstrating better control of breathing and better understanding of medication, triggers and symptoms. After completing the program, I give the patient an asthma action plan and refer him back to his physician for a final consult.
COMPLIANCE
One of the many benefits of a patient completing the program is that the physician is now dealing with a much more compliant patient. It’s difficult for many patients to consistently maintain an asthma diary, track medications and practice proper technique.
Therefore, part of the education plan consists of a compliance data program using a digital meter mounted to an inhaler with a sleeve adapter that records dates and times of medications used. Data is downloaded to a computer using the device’s docking station. The computer software has an audible alarm reminding patients to take their medications, and it provides analysis and graphics of patient data, showing:
• proper mixing and shaking of medications
• if inhale was effective or late
• if medication was dispensed adequately.
This gives physicians feedback and enables them to view a graphic report that shows if a patient is overusing or underusing medications, which can indicate an adjustment in meds. It keeps patients and physicians more in tune with what is going on once patients leave the office.
GOALS AND OBJECTIVES
Whatever program you develop, you must have specific goals and objectives along with specific outcomes. This is important when complying with NHLBI guidelines, as well as individual insurance companies, Medicare, Medicaid and so forth. However, an ultimate “goal” should be in preventing chronic symptoms and dealing with acute situations.
My particular objectives were based on increasing asthma awareness for the community and the patient. I focused on promoting environmental control and improving the availability of effective asthma therapy and management.
The most important outcome is having a more educated and compliant patient, which will likely improve clinician and patient disease management. It could result in lower direct or indirect costs, such as missed work or school time, through better long-term management.
While necessary to measure outcomes for any type of asthma program, it may take a while to gather enough information to predict outcomes. Give yourself some time to track trends, data compliance and follow-ups.
I was hoping that the number of our program’s asthmatics who visited the emergency room would decrease because of their asthma education. And, so far, not one of my patients has had to revisit the emergency room since completing the program.
STARTING OUT
What better place to start educating than in school classrooms? I went to the public schools in my area and taught asthma education. I was astonished to see how many children raised hands when I asked, “Does anyone here have asthma?” When I asked, “Does anyone here know someone who has asthma?” again the hands would go up. It reinforced my idea that an education center was overdue.
I also took my message to coaches of youth sports programs. As my own children began to get more involved in sports, I noticed how many times during a game coaches who knew I was a respiratory therapist asked me to help a child with exercise-induced asthma. I realized the coaches desperately needed a clinic to inform and instruct them on what they needed to do. I went to the board of directors of our local sports association and began to organize these clinics.
Parental education also is important because parents play a significant role in helping to control their children’s asthma and in educating their children. If the parents are in control, then the child is in control. Asthma education is vital in large part due to a fear of not understanding why something is happening. This is especially important for parents, as sometimes they can be blindsided by feelings of doubt about whether they are overtreating or undertreating their children.
Marketing your program to the physicians and to the community is one of the most strategic moves you will encounter. It’s crucial to remind physicians that the asthma center’s education and management services are available.
I got the word out by advertising in the county and local newspapers and offering free lectures to the community facilitated by physicians on staff at the medical center. The referrals began to come in from that point.
REIMBURSEMENT
In many cases, questions will arise about the cost for the patient to take part in the program. Most insurance companies reimburse for the program, depending on the contract your facility may currently have with them.
For example, some insurance companies may require seeing the initial assessment and evaluation before approving more than one visit. Others, such as Medicare, require a specific type of educational and therapeutic approach. You must do your research and contact your facilities’ contracted providers. Also, follow up on which CPT codes and ICD codes are appropriate for the services you are providing.
At Jupiter’s Asthma Education and Management Center, patients are billed only for the parts of the program they use. For example, if they do not use MDIs, then they do not need the compliance part of the program. If they do not use nebulizers at home, then they are not billed for that component. Therefore, cost could range anywhere from $450 to $1,100 per patient. It doesn’t matter which parts of the program patients use–once they complete the program, they are lifetime members and can come back anytime for support free of charge.
To try and offset the cost per patient, apply for grants from pharmaceutical companies and other professional organizations. You must do your research and find out which grants your program would be eligible for. Pharmaceutical companies are very helpful in providing educational materials. Be sure to contact the ones that provide respiratory medications.
It’s also important to set up separate accounts for patients who do not have insurance. Don’t turn anyone away; use whatever grants you receive to help provide them services. Asthma centers may generate some revenue, but serving as a community service should be the main focus.
The latest statistics show there are more than 17 million Americans affected by asthma, and the chronic disease is responsible for more than 5,000 deaths a year in the United States. Education and better self-management is the link to decreasing death from asthma in the majority of cases.
Wattles is education coordinator for cardiopulmonary services at Jupiter Medical Center in Jupiter, Fla.
Use as Sidebar:
Do Your Homework
If you want to see your asthma education program grow and succeed, it must be conducive to the area and environment in which you plan to establish it. Do your homework, and research thoroughly the area you intend to reach out to.
• How many other centers, if any, are located in a specific radius?
• If there are no other centers, is there a certain reason why?
• Are there some particular obstacles you should know about first?
• What population will you be treating?
• Will your program be more occupational or environmental, more adults than pediatrics, or equal distribution of both?
–Lynn Wattles
