Neighborhood Organization for Pediatric Asthma Management in the Neighborhood Asthma Coalition: Community Organization Approach to Provider Education
The asthma camp illustrates an important characteristic of the community organization approach. A conventional approach to attempts to help inner-city youth is to offer them a holiday from the inner city through attendance at summer camps in rural areas. Many asthma summer camps offer scholarships for inner-city children. This no doubt accomplishes many worthy things. The leaders of the Neighborhood Asthma Coalition, however, thought it better to develop a camp within the inner city. This had a number of advantages. First, it reached more children, 74, than could have been sent to rural camps. Second, it provided opportunity for an additional 76 sisters, brothers, and friends of asthmatic campers to attend, learn about asthma, and we hope, become more supportive of the asthmatic childrens’ needs. Third, it provided the opportunity to involve parents in planning, running, and participating in camp, again increasing their knowledge base from which to assist and support their children. Forty-two parents attended “education day” at the camp. In the terms of the Neighborhood Asthma Coalition, their strategy entailed investing in and building the inner city rather than merely giving a small group a respite from it. allergy medications
In planning the Neighborhood Asthma Coalition, we anticipated that health care available to asthmatic children and their caregivers in Grace Hill’s neighborhoods was adequate but that knowledge of asthma and the care asthmatic subjects should receive was inadequate, keeping children from fully availing themselves of desirable care. Thus, our initial program planning focused on raising awareness of asthma and its care among children and their caregivers to stimulate greater use of regular asthma care and less use of acute asthma care. In practice, we have found available care in the community appreciably wanting. For instance, evaluations of current practices, discussions with providers, and discussions with caregivers indicate substantial lack of availability of routine, preventive asthma care as opposed to episodic, acute care. For instance, Figure 1 portrays a breakout of the frequencies of cases receiving different numbers of routine, follow-up visits over a 1-year period. As can be seen, the vast majority had received no such care during the previous year, and only a very small percentage had received at least four visits, congruent with quarterly care.
We have addressed deficits in access to care in two ways. First, we have begun collaboration with the emergency department of St. Louis Children’s Hospital which provides a preponderance of the emergency care of the target audiences. Through this collaboration, the emergency department has developed a plan to ensure that all patients visiting the emergency department for acute asthma symptoms are advised to obtain follow-up from practitioners in the community within 72 h. Previous evaluation had indicated documentation of such advice was infrequent within the emergency department.
Figure 1. Proportions of subsample of 103 cases from Neighborhood Asthma Coalition receiving 0, 1, 2, 3, and 5 routine, asthma-related visits in year preceding recruitment.