Wednesday, March 21, 2001

Program cuts asthma visits

By Tim Bonfield
The Cincinnati Enquirer

        A large Greater Cincinnati physician group has claimed dramatic success at reducing hospital admissions for children with asthma.

        On Tuesday, at a medical conference in New Orleans, Dr. Elmer Martin, a pediatrician with Group Health Associates, reported that the group's asthma management program has resulted in a 60 percent reduction in hospital admission rates for children from 1993 through 2000.

    Group Health Associates, one of the Tristate's largest doctor groups, reports that its asthma-management policies result in fewer patients needing hospital care than national averages. Figures show the number of hospital admissions for every 1,000 asthma patients per year.
    Year GHA National
    1993 3.4 2.8
    1994 2.5 2.95
    1995 2.4 3.96
    1996 2.5 3.38
    1997 2.2 3.6
    1998 1.7 2.8
    1999 1.3 *
    2000 1.4 *
    Source: Group Health Associates * 1999 and 2000 national figures are not available.

        “All the experts say the same thing. Asthma admissions are largely avoidable,” Dr. Martin said. “Hospital admissions are expensive, stressful to the family and worst of all, some kids die.”

        Asthma is a chronic lung disease that causes wheezing and difficulty breathing when airways become inflamed. Nationwide, asthma affects more than 4 million children under age 15, causing more than 550,000 emergency hospital visits and more than 150 deaths a year.

        In 1993, Group Health Associates reported 3.4 hospital admissions per year for every 1,000 asthma patients it served. By 1999, that rate was down to 1.3 admissions per 1,000 patients.

        The GHA results shatter the standard set by Healthy People 2000, a collection of public health goals drafted by the federal government. That plan called for asthma admission rates to be reduced to an average of 2.25 per 1,000 patients by the year 2000.

        As of 1998, the most recent data available, the national average was 2.8 admissions per 1,000 patients.

        Dr. Martin said the improvements have come from convincing more than 30 group doctors to consistently follow detailed standards of care for more than eight years.

        The group's asthma management plan includes no radical treatments or unheard-of medicines. Instead, it emphasizes family education, prescribing a home supply of common asthma control medications, and increasing efforts to track down factors that trigger asthma attacks.

        “The medications out there to control asthma are better now,” Dr. Martin said. “But we found that patients weren't getting education. And people didn't want to take their medications.”

        The Group Health program includes:

        • Daily use of anti-inflammatory medication.

        • Using a peak-flow meter to measure breathing capacity.

        • Using a nebulizer or aerochamber at home to improve breathing when asthma symptoms begin.

        • Keeping a home supply of anti-inflammatory steroids for asthma flare-ups.

        • Referring children with asthma to allergy specialists to search for triggers.

        • Developing written “action plans” detailing exactly what families should do when their child suffers an asthma attack. Such plans include which medicines to use at which dose, when to call the doctor and when to go straight to the hospital or call an ambulance.

        “This system works positively regardless of the patient's residence area, insurance status or age,” Dr. Martin wrote in his study.

        Families that participate often notice significant improvement in their childrens' day-to-day health.

        Erlanger resident Jim Stone said his 8-year-old son, Jacob, has had far fewer bad asthma days since he started following the Group Health program about two years ago.

        “It's just been a remarkable improvement,” Mr. Stone said. “He hasn't really had a bad day for several months. He used to get pretty clogged up once or twice a month.”

        The biggest challenge: finding the time to provide regular data and feedback to doctors, Dr. Martin said.

        “It takes effort to keep after doctors to keep after families,” Dr. Martin said.

        Working with different insurance companies, all of which have their own rules about what they cover, has been a hassle but largely successful. Some take more convincing than others, but most plans have covered everything the program recommends, Dr. Martin said.

        Another important factor in reducing hospitalizations has been increasing use of allergy specialists.

        Earlier this month, a study by Dr. Bruce Lanphear, an environmental-health expert at Children's Hospital, reported that nearly 40 percent of children under 6 who suffer from asthma could avoid the disease if three common causes of allergy were removed from their homes: tobacco smoke, pets and the use of gas stoves for heat.

        The fact is, many children with asthma never see an allergist, and thus never learn what may be triggering their attacks.

        The Group Health program increased the overall percentage of asthmatic children seeing allergists from about 40 percent in 1993 to more than 55 percent in 1999, Dr. Martin reports.

        The improvement was even stronger among low-income patients; from 30 percent in 1993 to about 55 percent in 1999, he said.

        However, getting families to make lifestyle changes to prevent an asthma attack can be harder than teaching them how to cope when an attack occurs.

        “It's an important problem,” Dr. Martin said. “It's amazing how many kids I see that come in with their parents smelling like smoke. We advise parents not to smoke around these kids, but some do anyway.”

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