Building Bridges for Asthma Care: Reducing School Absence for Inner-City Children With Health Disparities

Abstract

To assess the effect of a school-based asthma care program on improving school attendance and asthma control.Researchers in this study included children ages 5 to 14 years in 28 schools within the Denver and Hartford public school systems who were managed for 2 consecutive school years.Students were identified by using school health and medication authorization forms; risk was assessed by using the Asthma Intake Form, which used self-reported criteria such as emergency department or hospital visits, oral steroid requirement, school absenteeism, and markers of uncontrolled asthma. Students and their caregivers received targeted case management, including asthma education, inhaler training, regular school nurse visits, assessment of asthma control, and coordination with primary care. The control group consisted of matched children who did not participate in the program. The primary outcome was rate of absences; secondary outcomes included rescue inhaler use and Asthma Control Test (ACT) scores.Of the 2178 students who were identified as having asthma, 1390 returned an Asthma Intake Form, and 781 met high-risk asthma criteria. A total of 463 high-risk students were enrolled in the Building Bridges for Asthma Care Program, 292 declined to participate, and 26 were lost to follow-up. The majority of Building Bridges program participants were Hispanic (69.5%) or black (20.5%); 59% were boys. Participants experienced a 22% absolute decrease in school absenteeism, which equates to 5.5 additional days of school attendance per student per year. Likewise, the number of children with ACT scores of less than the control threshold of 20 decreased from 42.7% to 28.8%. Bronchodilator use >2 times per week decreased from 35.8% to 22.9%, and ACT scores improved in 37.4%. School nurses spent ∼120 minutes per week implementing the program.School-based interventions with an emphasis on school nurse involvement can both reduce school absenteeism and improve asthma control by coordinating care with children, their caregivers, and clinicians. Time spent by school nurses in program implementation was manageable and may be justified by time saved in acute asthma management. Limitations of the study include nonrandomized selection of controls and lack of data regarding the actual reason for school absences.This study highlights how school-based asthma management programs can improve asthma control and reduce school absenteeism with the potential for far-reaching impact. Broad application of such programs should be considered.