title: A community-based strategy for improving asthma management and outcomes for preschoolers.
abstract: Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003-2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p < .001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar = 3.77, p = .052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar = 11.1, p < .001), ED visits (72% to 43%, McNemar = 19.2, p < .001), and hospitalizations (24% to 11%, McNemar = 5.54, p = .018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar = 9.8, p = .001), ED visits from 72% to 37% (McNemar = 14.4, p < .001), and hospitalizations from 35% to 15% (McNemar = 8.33, p = .003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.
authors.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA. sef5@columbia.edu
authors.forename: Sally E
authors.initials: SE
authors.lastname: Findley
authors.forename: Gloria
authors.initials: G
authors.lastname: Thomas
authors.forename: Rosa
authors.initials: R
authors.lastname: Madera-Reese
authors.forename: Natasha
authors.initials: N
authors.lastname: McLeod
authors.forename: Sreelata
authors.initials: S
authors.lastname: Kintala
authors.forename: Raquel
authors.initials: R
authors.lastname: Andres Martinez
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ortiz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Herman
mesh_terms: D001249:Asthma / Q000628:therapy*; D002656:Child Day Care Centers; D002675:Child, Preschool; D018672:Community Health Planning / Q000379:methods*; D018479:Early Intervention, Educational; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D006265:Health Care Coalitions / Q000458:organization & administration*; D006801:Humans; D010290:Parents / Q000193:education*; D010353:Patient Education as Topic; D010379:Peer Group; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome