Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers.
Lisa Cicutto, Melanie Gleason, Christy Haas-Howard and 12 others
PMID 30336726WHAT IT FOUND
In a school nurse-led asthma program, school care plans in 382 analysed students rose after enrolment from 62.0% to 84.8%, reliever inhalers from 58.4% to 78.7%, home plans from 41.6% to 61.2%, and technique from 2.9 to 3.9 of 5.
Key findings
01School nurses led a five-step asthma program in two urban districts, and 463 of 781 at-risk students enrolled.
02In the process outcome analysis (total N = 382), school asthma care plans rose from 62.0% to 84.8%, quick-relief inhalers at school from 58.4% to 78.7%, home action/treatment plans from 41.6% to 61.2%, and inhaler technique from 2.9 to 3.9 on a 0-5 scale.
03Most enrolled students received the core steps: 93% had three or more school visits, and 88% had three or more letters sent to health-care providers.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a quality improvement project without a control group, so changes after enrolment cannot be separated from ordinary school routines or other factors. The article reports process indicators, not asthma control, absenteeism, or health-care use outcomes; those outcomes are described in a separate publication. Only 60% of at-risk students enrolled, and families declined because they thought asthma was not severe, contact information was wrong, or the program took too much time. Implementation was studied over 2 years in urban schools, so long-term sustainability and rural schools with different resources are unknown. The process outcome analysis included 382 students, while 463 enrolled, and the paper did not examine individual behavior changes of students and families.
Declared interests
GlaxoSmithKline funded the study (FLV116794), and several authors received support from GlaxoSmithKline. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the increases in care plans, inhalers, home action plans, and technique scores as proof that the program improved asthma control, attendance, or health-care use. This paper reports a school nurse-led quality improvement process without a control group. The program included many components, so the contribution of any single element cannot be separated, and clinical outcomes are published separately.