Neighborhood Organization for Pediatric Asthma Management in the Neighborhood Asthma Coalition: Analysis of Problems Deficits in Basic Care
Lack of understanding or appreciation of the importance of basic care seemed implicated in the study of asthma deaths noted above. Such misunderstanding may also be inferred from results of a study of two groups of adults with asthma, one composed of mostly white, mostly middle-class patients from a suburban practice, and one from the same inner-city neighborhoods as are the focus of the Neighborhood Asthma Coalition. In addition to rating economic problems as more pressing than the patients from the suburban practice, the inner-city patients rated asthma as less a concern, and indicated they were less careful to take their asthma medications, more satisfied with over-the-counter medications for asthma, and more likely to try to fight asthma attacks on their own without medical help.
In addition to limited economic resources for medical care and lack of understanding of basic asthma care, experience in working with the neighborhood asthma coalition has revealed numerous, concrete barriers to treatment which, unless pointed out by neighborhood residents, would have gone unnoticed. Canadian health & care mall Reading here For instance, pharmacies are not open 24 h a day in low income neighborhoods, and residents do not have transportation to find outlets that are. We wonder how many times frustrated clinicians have attributed to lack of interest rather than to lack of an open pharmacy the failure of an overwhelmed mother to fill a prescription written in the emergency department on a weekend evening.
While some of the reasons for lack of basic care reflect either the disadvantages or lack of understanding of asthmatic children and their caregivers, we have also found problems in the care available to the Neighborhood Asthma Coalition participants. For instance, in one audit of provider data, we found 77% of participants not to have had a single nonemergency visit for asthma during the previous year. The National Asthma Education Program’s ideal of routine, prospective asthma care is a rare event in these neighborhoods. Anecdotally, professionals seem resigned to this state of affairs. They report the futility of scheduling routine follow-up visits and have come to accept a pattern of urgent and emergency care as the standard.