Abstract
Background: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma care management. To address the needs of these underserved children and families, we developed and implemented the Regional Asthma Disease Management Program (RADMP). A multi-faceted approach is used to help families build skills in managing environmental triggers and connect them with community resources. The RADMP provides holistic care management, addressing social determinants of health in children with asthma who are at risk for lower school performance, decreased attendance, fragile nutritional status, and inadequate housing. Children and families are given care and education in their homes, childcare centers, and/or schools.
Methods: This retrospective study was conducted from October 1, 2018- April 30, 2019 in 15 rural counties and the Eastern Band of Cherokee Indian Reservation in western North Carolina. Community and individual components included holistic asthma disease management, asthma education in-services, and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Mission Health System Institutional Review Board (IRB) approval was obtained.
Results: All children had persistent asthma (mild, moderate and severe) and were all uncontrolled as per NIH criteria. Two hundred and one children received holistic asthma care management, resulting in 636 in-person consults and 1,018 telephone consults. Comprehensive environmental assessments and asthma education was provided to 63 individuals in 21 different homes. Home remediation primarily in the form of mold mitigation and integrated pest management was conducted to create an asthma-friendly home. Nine asthma educational in-services were provided to health care professional groups, community organizations and families to include a total of 1,384 people.
Conclusions: The Regional Asthma Disease Management Program provided holistic asthma care management to decrease environmental exposures, decrease exposure to irritants and provide asthma education for rural, impoverished asthmatic children as well as their families in western North Carolina. By creating an asthma friendly environment, this program resulted in improved asthma-related outcomes.
Footnotes
Commercial Relationships: Melinda Shuler has the following disclosures: (1) Association of Asthma Educators Executive Board of Directors; (2) NAEPP-NHLBI Coordinating Committee; (3) Journal of Asthma Peer Reviewer; (4) Western Schools Content Editor; and (5) TEVA. There are no additional disclosures.
Support: United States Environmental Protection Agency (US EPA)
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