Vol. 15 •Issue 9 • Page 18
Starting Community Asthma Clinics
Many rewards, challenges come with treating low-income, urban populations.
Asthma is a formidable problem among low-income, urban children. Morbidity is high, and the disease is generally poorly controlled and managed, causing numerous emergency room visits and multiple hospitalizations.
These children are disproportionately affected by asthma, and they only may receive episodic treatment due to lack of access to quality care and other barriers such as language, ability to pay, and transportation.
Many communities across the country have created specialized clinics for low-income, urban community members with asthma to successfully counter these problems.
A needs assessment
Many questions must be answered prior to opening a community asthma clinic:
- How many people in the community have asthma?
- Is there any other access to specialized care for asthma?
- How many patients with asthma go to the local ER?
- If many patients use the ER as their primary care, is it because of convenience, the extended hours, having no insurance, etc.?
- What’s the hospitalization rate due to asthma in your community?
- How long are their hospital stays?
- Which patients have repeated visits to the ER or hospital?Once these questions are thoroughly explored, you will have your target population.
Data on your community also can be found through the Census Bureau and the Behavioral Risk Factor Surveillance System. These sources can help you check the area’s demographics. Look at the age of your population, average education level, and the languages spoken. You also can access your local health department and ask for epidemiological information on asthma prevalence and incidence in your community.
Additionally, check the Centers for Disease Control and Prevention’s asthma surveillance database to see if it has any asthma prevalence information germane to your community.
Creating a mission statement
Having a goal and mission statement is important. For example, the American Lung Association’s mission is to prevent lung disease and promote lung health. This mission drives the ALA’s programs and development initiatives.
A goal and mission statement will be your compass as you seek funding, location, staffing, programmatic activities, and equipment. If your goal is to provide basic treatment and education, then you will need less space and staffing.
If you want to perform advanced pulmonary function testing, allergy testing, or draw blood samples for allergy and immunology screening, you’re going to need more room and more specialized staff such as a pulmonologist or nurse practitioner.
Acquiring funding
Several sources for grants such as www.grants.gov and www.nih.gov/grants are worth checking out.
You may want to hire someone with proven grant-writing skills or secure a development consultant. Partner with local hospitals and universities for support. A university professor with an interest in asthma management and treatment could help acquire governmental funding.
Contact donor organizations such as the Robert Wood Johnson Foundation (www.rwjf.org) or local community groups. Also, pharmaceutical companies might be interested in making a donation. Become familiar with your local asthma reps and pitch the idea of funding community asthma clinics.
Location, location, location
A partnership with a hospital or other health care clinic may be able to provide you clinic space to use during their off-hours. You also may want to consider establishing clinic hours comparable to the times the ER has the most asthma patients.
The clinic’s location must be easily accessible to your target population. It would be best to have it near a source of public transportation.
If you have a waiting area, it should be comfortable for your patients by providing adequate seating and a play area for children. Many suburban clinics are in areas where low-income patients feel out of place and don’t speak the language.
Also, make sure your clinic and amenities are handicap accessible.
Depending on the population, you may want to consider a mobile clinic. These clinics on wheels can serve areas that have inadequate access to health care facilities due to lack of transportation. The Asthma and Allergy Foundation started the Breathmobile program in 1995 to provide free asthma care and education to low-income school children with asthma in Southeast Los Angeles County.
The Jackson Heights Health Center, an affiliate of New York Hospital Queens, started a program in 1997 with a 42-foot mobile van where people were treated and educated. At first, the van stayed in a remote location, and then, in 2000, it started traveling throughout Queens.
These programs have reduceed sick visits to the doctor and ER, hospitalizations, and absenteeism in those they treat.
Staffing issues
At a minimum, you can use a respiratory therapist and a med tech. It’s also helpful to have a nurse practitioner on staff.
Consider appointing a medical director to oversee operations. The medical director doesn’t have to be there full time, only to give guidance.
Physician input is needed for action plans, reading pulmonary function tests, and prescription writing. The doctor should guide the management of asthma exacerbations, including doses, timing, and treatment algorithms based on guidelines by the National Heart, Lung, and Blood Institute.
Use volunteers from local associations to help with reception and appointment duties. Partner with professional schools, and enter into an agreement where their students work practicum hours with you in exchange for practical experience or a course grade.
The local ALA in Georgia has established various formal and verbal agreements with universities and professional schools for staffing its 26-year-old residential pediatric asthma camp program, Camp Breathe Easy, where approximately 200 children attend each year.
This camp program sets up a community clinic of sorts one week each summer, and the clinic is staffed by volunteers, including nurses, RTs and medical students.
Supplies you will need
Your supply list depends on the scope of your practice and your partnerships with other facilities. Supplies needed beyond the typical physician’s office may include allergy tests, spirometers, and respiratory treatment equipment.
Some hospitals donate items or sell them at a discount as part of their charity care. Other medical supply organizations sell items at discounted rates for non-profit clinics.
Your clinic services will dictate what furniture you need. If you’re using an area of an existing practice, you could use some of their equipment. However, if you’re starting from scratch, you must purchase exam tables, locked file cabinets, desks, and chairs.
Organizations such as Volunteers in Health Care have programs to help set up free community clinics. You can find information at www.volunteersinhealthcare.org/reports/rptpdfs/accessnet.pdf .
Access to medications
Many low-income families without insurance find themselves having to choose between paying for housing and food, and buying medications. The cost for inhaled corticosteroids and long-acting bronchodilators may be out of reach for these families, whereas a short-acting bronchodilator is inexpensive. Without prevention medications, they’re left to treating episodes and may use the ER more frequently.
Even though pharmaceutical companies provide samples, you can’t rely solely on them. Drug assistance programs supply patients with their medications at a significantly reduced rate. Many pharmacies have discounted medications for clinics as well.
Consulting with a social worker or case manager may provide other places for your patients to access their medications.
Getting the word out
Speak with members of area community groups or places of worship. Contact local physicians and health care facilities and let them know about your clinic.
Explain to the local ER that you have office hours complementary to theirs. You can even begin a catchy marketing campaign that encourages community members to come to you before the ER.
Stress your mission is to help ERs with the care and education of some of their patients and not to take their patients away.
As education is a large part of asthma clinic services, you will need to provide materials to your patients. Organizations such as ALA, Allergy and Asthma Network Mothers of Asthmatics, and the American Academy of Allergy, Asthma, and Immunology will supply you with patient education materials at low or no cost.
The Internet also can be a source of materials in a variety of languages. Remember to provide information at an appropriate readability level for your population.
You want your constituents to comprehend the information and apply it; if it’s too advanced, you will defeat your purpose.
Your local ALA also may have trained volunteers willing to come and provide asthma education to your patients. Education is critical, so spend some time thinking about how your program will incorporate it.
Some final points
Consider establishing a community advisory board. It should consist of community stakeholders and those who have made contributions to children with asthma or other special health care needs.
These people can be pulmonologists, allergists, asthma nurses, asthma educators, parents of children with asthma, school nurses, social workers, etc. This board will help you in all aspects of your community clinic from planning to implementation.
Establish a regular time to meet and delegate activities to them. Opening up a community clinic is no small feat, so you will need buy-in from key volunteers who are committed to the cause and not already overextended.
Finally, think about a name for your clinic. It should be inviting yet practical.
Opening an asthma clinic will be a challenge, but it won’t be without its rewards. Your service will be a direct benefit to your patients as well as the entire community. Just wait and see.
For a list of resources, look under the “From Print” toolbar on the left side of our home page at www.advanceweb.com/respmanager.
Chanda Nicole Mobley, DrPH, MPH, is the director of pediatric asthma programs for the American Lung Association — Southeast Region, Atlanta. Martha C. Treber, MS, RRT-NPS, CPFT, AE-C, is the director of clinical education for the department of respiratory care at Midwestern University, Wichita Falls, Texas. They’re both members of the Association of Asthma Educators’ Board of Directors.
