A new grant from the National Institutes of Health (NIH) will provide support for the University of Rochester Medical Center’s Preventive Care Asthma Program – a program that has improved health outcomes for school children with asthma – to help teenagers in Rochester who are suffering from significant asthma and related breathing problems.
The grant, which is funded for $4.3 million over 5 years, supports the “Telemedicine Enhanced Asthma Management-Uniting Providers for Teens (TEAM-UP for Teens)” program, which helps provide the following treatment support for teens with asthma:
- Telehealth visits with an asthma specialist to develop an optimized asthma management plan at the start of the school year
- School-based supervised therapy of preventive asthma medications – providing support to teenagers with their treatment to ensure they are taking medicine consistently and correctly
- Follow-up telehealth visits with a nurse asthma educator to support teens and their caregivers with ongoing asthma management
The preventive asthma care program is led by Jill Halterman, M.D., M.P.H. Halterman is a general pediatrician, not an asthma specialist. But, when she saw how asthma disproportionately affected urban children, she was compelled help. A partnership with the city school district and school nurse program has allowed her and her team to reach hundreds of children with asthma in the community.
“My goal was to improve the delivery of care to children and teens who are suffering the greatest burden from asthma,” said Halterman, Executive Vice Chair and Professor of Pediatrics.
More than 10 percent of children in the city school district suffer from asthma, and in Monroe County, hospitalization rates for asthma are five times higher in the city than in suburban areas. Due to a number of barriers to care, however, children living in the district often don’t receive or benefit from the preventive asthma treatments that they need. As a result, their symptoms worsen, they miss school, and their parents have to miss work. Some children end up in the emergency department or in extended hospital stays.
“After the crisis passes, many of these kids don’t receive follow-up care,” said Christy Lamberton, a nurse at School No. 45. “So they never get on the right treatment plan, and their symptoms never improve.”
As part of the preventive asthma care initiative – which has been active in Rochester for more than 15 years — children receive their preventive asthma medication each day under the guidance of a school nurse or health aide. This model of care has improved children’s symptoms, supported families with many competing demands, reduced absenteeism, and allowed children to be more active.
“We have seen that when kids consistently get their preventive medication at school, they notice after a time that they feel better and are able to participate more,” said Lamberton.
The program now includes a telemedicine component that connects children in schools to primary care providers in the office. These providers help to determine the best form of therapy and then stay readily available in a child’s care. Halterman’s study of the program found that children who receive both telemedicine support and therapy at school are almost half as likely to need an emergency room or hospital visit for asthma.
This new grant has expanded the existing program for teenagers because Halterman noticed there were gaps of care for teens with more severe illness, at least in part due to lack of needed specialist care.
“Many of these teens were not seeing an asthma specialist and were not receiving optimal medications for their level of asthma severity, and some had untreated allergies that contributed to their asthma. Therefore, we wanted to help connect them with a specialist to ensure they could receive guideline-based treatment,” she said.
Even though the city school district has started the school year with full remote learning, the program has adjusted to continue with minimal disruption, according to Halterman.
“For the telemedicine visits, that’s been relatively easy. We can still connect to a specialist provider using home-based Zoom meetings. For the supervised nurse therapy, we’re piloting an approach where the teens can use an app to film themselves using medication, and nurses can review the videos and provide any needed support to help them use their medicine on-time and correctly.”
Halterman’s school-based asthma treatment program has been an influential model for other school districts across the country. Nine other sites, including districts in New York City, Philadelphia, and Columbus, OH, have consulted with Halterman’s team and implemented similar programs. In Columbus, Elizabeth Allen, M.D., a pediatric pulmonologist, came across the program after she and her team identified asthma improvement as one of their top priorities.
“We started looking into Dr. Halterman’s program and it stood out as effective and well-vetted to work,” said Allen. “It’s effective, because for families who have barriers to receiving quality asthma care, you need to give added assistance to ensure children have the right medications — and that they receive those medications on a regular basis.” Dr. Allen has now implemented the program throughout the Columbus, Ohio city school district and has seen benefit for hundreds of children.