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Effectiveness of Community Based Interventions for Children with Asthma
Noreen M. Clark, PhDMyron E. Wegman Distinguished University ProfessorDirector, Center for Managing Chronic DiseaseUniversity of Michigan
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Effectiveness of Community Based Interventions for Children with Asthma
Noreen M. Clark, PhDMyron E. Wegman Distinguished University ProfessorDirector, Center for Managing Chronic DiseaseUniversity of Michigan
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In asthma, four types of community interventions have been examined
Outreach from health care institutions
Home based computer programs School based programs Coalitions and partnerships
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Outreach to patients’ homes by community health workers to:
Provide self-management education
Assist with environmental modifications
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Summary of Studies: Community health worker based randomized trials
PublicationSample Size Intervention Outcome
Williams et al, National Medical Association, February 2006
N=410Modification of Environment
Reduction in dust mite; improved functioning (most severe)
Krieger et al, American Journal of Public Health, April 2005
N=274
High vs. low intensity environmental control & education
Improved quality of life; less urgent care
Evans et al, Journal of Pediatrics, September 1999
N=1033
Social workers individualized education for family
Fewer sick days; less hospitalization; greatest effect for severe asthma
Carter et al, Journal of Allergy & Clinical Immunology, 2001
N=104Assistance with home prevention (3 Groups)
Reduced acute visits in active intervention; slight reduction in allergen presence; decrease in mite allergen
Brown et al, Journal of Pediatric Psychology, 2002
N=95"Wee Wheezers" at home < 7 years old
Fewer SX days for younger children only. Better quality of life for parents of younger children
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Issues
Effects of environment change not separated from education
Cost of environmental modifications
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Computer Programs for Home Use
Computer programs focus on games and problem solving
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Summary of Studies: Computer programs at home randomized trials
Publication Sample Size Intervention Outcome
Hass et al, Journal of Pediatric Health Care, March 2003
N=101 Asthma Game NS
Shegog et al, Journal American Inform Association, January 2001
N=76Self Management
EducationIncreased self-
efficacy
Homer et al, Pediatrics, July 2000
N=137Asthma &
Management CAI vs. Written
NS
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Issues
Limited success Majority of studies test knowledge Small numbers Overlooks children without computers
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School Based Interventions
Focus on child’s self-management
Conducted with and without school based health services
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Summary of Studies: School based randomized trials
Publication Sample Size Intervention Outcomes
Evans et al, Health Education Quarterly, Fall 1997
N=239 Self ManagementReduced SX; reduced ED
visits; better grades
Shah et al, BMJ, March 2001
N=272Peer Education re:
Asthma Management
Improved quality of life and reduced absenteeism
Gus et al, Journal of Adolescent Health, October 2005
N=273School Based Asthma
Clinic
Reduced hospital & ED visits; care costs reduced
Tinkelman & Schwartz, Journal of Asthma, June 2004
N=41Asthma Self-
Management Education
Reduced missed school days & unscheduled doctor visits; reduced SX
Halferman et al, Archives of Pediatric & Adolescent Medicine, May 2004
N=180 School Based MedsReduced missed school
days and SX
Clark et al, Chest, May 2004
N=835Comprehensive
Management Education
Reduced SX in persistent group; better grades; fewer missed school days
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Issues
Difficult in school systems with limited resources
Replication generally does not occur Sponsorship not forthcoming
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Coalitions and Partnerships
200+ asthma coalitions in the United States
Focus on community-wide changes
Bring disparate but key groups together
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Evaluation Logic
Eventual improved health status results from: Health system-wide changes Community-wide policies
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Summary of Studies: Community Coalitions & Partnerships
Publication Intervention Outcomes
Kreger et al, Report of California Community Action to Fight Asthma Initiative, 2005
11 Coalitions Across California
• Community education re: housing rights• Public education re: asthma• School environment assessments• Advocacy for air quality• Asthma action plans in schools community-wide
Fisher et al, Pediatrics, December 2006
Neighborhood Asthma Coalition
Reduced acute care rates among high level of participants
Clark et al, Health Promotion Practice, April 2006
7 Asthma Coalitions Across the United States
• Community wide pt registries (2)• Care coordinators across hospitals & clinics (2)• Integration of CHW with Clinic Care (4)• Community wide education for clinicians (6)• Environment Control Policies (1)
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Issues
Lack of outcome of studies Support has been from foundations Population data not collected
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In Summary
Good models of interventions exist for: community outreach (CHW) school based programs coalitions and partnerships
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Trends
Less examination of social, behavioral, policy interventions
Work of community health workers not being reimbursed
No continuing sponsorship for school programs or coalitions
Proven programs not disseminated Reinvention of the wheel
Asthma fallen off the radar
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Ideas to Enhance Application Initiate a targeted campaign to reach
health system influentials: ongoing messages and encouragement to support use of proven programs
Provide a compendium of proven programs and “how to’s” as part of the campaign
Funders initiate research into effective channels for dissemination of programs
Reinvigorate support for community intervention research including evaluation methodology
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Effectiveness of Community Based Interventions for Children with Asthma
Noreen M. Clark, PhDMyron E. Wegman Distinguished University ProfessorDirector, Center for Managing Chronic DiseaseUniversity of Michigan