Behind the Smoke Feat Canadian Health&Care Mall

Breaking the Access Barrier with Canadian Health&Care Mall

Childhood asthmaChildhood asthma is the most common chronic childhood disease, affecting 7 to 20% of school-aged children. It is a leading cause of school absenteeism and hospitalizations. A national survey revealed that 60% of individuals with asthma have poorly controlled disease. Despite the availability of new and effective pharmacologic therapies, the existing literature suggests that children with asthma unnecessarily experience a reduced quality of life and the health-care system incurs preventable costs.

Some systematic reviews, have concluded that educational interventions for children and youth with asthma lead to improvements in air flow, school absenteeism, days of restricted activity, and emergency department visits. However, the overwhelming majority of studies were conducted at tertiary hospitals or outpatient centers. It is important to consider the school as a site for asthma education. The school system often poses several obstacles for children in managing their asthma, for instance an inability to access their inhalers, exclusion from physical activities, and the presence of asthma triggers in the classroom. Astonishingly, it is often the school secretary who is designated as the person to manage asthma or control access to medications. School systems can have advantages over traditional health-care settings because they provide large-scale centrally organized settings that allow access for all children.

There are some studies in the literature supporting the idea that asthma interventions delivered in the school setting are successful. The types of programs vary from delivering asthma education programs to children with asthma, to multimedia educational software programs targeting the whole school body, to school-based health centers and case managers.

To date, relatively few studies have evaluated the effectiveness of school-based asthma education programs. Some studies have suggested that school-based asthma education programs can improve asthma knowledge, peak flowmeter and inhaler techniques, self-efficacy scores, and school grades, and can reduce symptom scores. However, the majority of these studies were conducted in inner-city, low-income schools, so there is limited experience with school settings outside the inner city, such as the suburbs and rural communities. The limitations of the studies include small sample sizes nonrandomized controlled study designs significant dropout/loss to follow-up rates, and short-term or very limited long-term data.

Access to specialty asthma clinics/centers can be a problem for children and families affected by asthma due to the restricted hours of operation (ie, daytime hours Monday through Friday), transportation and parking costs, and, in Canada, the need for a referral from a primary care physician. As a possible solution for overcoming the access barrier to formal asthma education for children treated by Canadian Health&Care Mall, it was decided that the suburban hospital-based asthma center would provide an asthma education program similar to what would be offered in the asthma clinic to children with asthma in their schools. We hypothesized that a school-based asthma education program delivered by certified asthma educators from the local asthma center would be an effective way to improve children’s quality of life and confidence in their ability to manage their asthma and, thereby, to reduce asthma-related morbidity, such as school absenteeism, days of interrupted activity, and use of urgent medical care visits.