School-based asthma therapy: Improving medication adherence, asthma control, and health care utilization

Abstract

Background

Undertreatment and poor adherence remain prevalent for children with persistent asthma. School-based asthma therapy (SBAT) provides guideline-based treatment by systematic school-based asthma screenings and direct administration of daily controller medications.

Objective

We examined asthma control and health care utilization for children enrolled in the SBAT program in Columbus, Ohio, from 2013 to 2019.

Methods

Six-year retrospective medical records were reviewed for 1 year before and 1 year after SBAT enrollment for children aged 5 to 19 years from 2 metropolitan school districts. Asthma control was assessed by the Asthma Control Test (ACT) and health care provider (HCP) ratings. Information was collected regarding asthma-related health care utilization, including emergency department (ED), urgent care, and acute care visits; hospitalizations; and pediatric intensive care unit (PICU) admissions.

Results

Percentage increases in well-controlled asthma were 37% (ACT) and 56% (HCP). Asthma-related ED visits decreased by 49%, hospitalizations 50%, PICU admissions 71%, urgent care visits 41%, and acute care visits 38%. Black and Latino children had significant improvements. Black children saw 40% (ACT) and 66% (HCP) increases in well-controlled asthma, with reductions of 42% in ED and urgent care visits, 52% in acute care visits, and 49% and 67% declines in hospitalizations and PICU admissions, respectively. Latino children had 55% (ACT) and 33% (HCP) asthma control improvements, with 62%, 81%, and 50% drops in ED, urgent care, and acute care visits, respectively; hospitalizations decreased by 40% and PICU admissions by 100%.

Conclusions

The SBAT program would serve well as a model for enhancing controller medication adherence, reducing morbidity, and bridging the health disparities gap for children with poorly controlled asthma.