Care for California kids with asthma falls short

"Emergency department visits for chronic conditions such as asthma are frequently the bellwether of sub-optimal primary care and community-based support," says Ulfat Shaikh. (Credit: iStockphoto)

Children with asthma in California face several challenges, largely due to low flu vaccination rates, medication compliance, and limited access to primary care doctors.

A new report offers a number of public policy strategies that could help remedy these shortcomings.

“Asthma is one of the most common chronic pediatric conditions in the US and a major reason for emergency department visits and hospitalizations in children,” says Ulfat Shaikh, clinical quality officer at the California Department of Health Care Services and director of Healthcare Quality at the University of California, Davis, School of Medicine.

“Emergency department visits for chronic conditions such as asthma are frequently the bellwether of sub-optimal primary care and community-based support. However, by creating better support structures around these children, we can have a significant impact on their health and quality of life.”

500,000 children have asthma

To understand the status of asthma in California, the researchers mined data from the 2011-12 California Health Interview Survey, which includes 44,000 households from every county in California.

Nearly 10 percent of the state’s children, close to 500,000, suffer from asthma. The care these children receive can vary widely, even though more than 96 percent have a primary care provider.

Most concerning is that their flu vaccination rates are not much different from the general pediatric population. Flu can pose a significant health risk, sending many children with asthma to the hospital.

“We were surprised to see that about half of all children with asthma had not received a flu shot in the past year,” Shaikh says. “Children with asthma are at high risk of becoming really sick from the flu and of developing pneumonia, even if their asthma is mild or their symptoms are well-controlled.”

Health care safety net

The study, published in the journal Population Health Management, also highlights problems with asthma control. A third of children with asthma had to go to the emergency department for asthma symptoms in the past year. For 20 percent of them, this was because of an inability to see their own health care provider.

Even more striking: only 38 percent of children with asthma receive a written-care plan from their clinicians.

While the primary care shortcomings are deeply troubling, the researchers point to solutions:

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A safety net of existing providers and resources could support primary care providers’ efforts to combat pediatric asthma, but involving interdisciplinary teams for population-health management of pediatric asthma is key.

Pharmacists, school nurses, social workers, community health workers, and emergency department patient navigators could be enlisted to encourage vaccination, improve medication compliance, follow up higher-risk children more closely, point families toward resources, and educate families to improve self-care.

“These findings are important because they will better guide our efforts to improve both clinical quality and population health for our children with asthma,” says Neal Kohatsu, medical director at the California Department of Health Care Services, which partially funded the study.

Robert Byrd, associate professor of clinical pediatrics is coauthor of the study that was supported in part by the UC Davis Institute for Population Health Improvement and California Department of Health Care Services Interagency Agreement.

Source: UC Davis