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The Infant Welfare Society’s Asthma Management Project* FREE TO VIEW

Diana Wright, ND, CPNP
Author and Funding Information

*From The Infant Welfare Society of Chicago, Chicago, IL.

Correspondence to: Diana Wright, ND, CPNP, The Infant Welfare Society of Chicago, 1931 N Halsted St, Chicago, IL 60614

Chest. 1999;116(suppl_2):202S-203S. doi:10.1378/chest.116.suppl_2.202S
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The Infant Welfare Society is a large, Chicago-based community health center serving indigent women and children. Since the turn of the century, its mission has been to “provide services for the healthy physical and mental development of disadvantaged children to give them a foundation for a productive future and wholesome life.” In fulfillment of its mission, Infant Welfare provides comprehensive primary care to children from birth through the age of 19 years. The health center also provides prenatal and gynecologic care to women, and offers mental health and dental services as well. Although the services are open to all, Infant Welfare’s patients are predominantly Hispanic; many are recent immigrants and do not speak English. Services are delivered by three pediatricians and four nurse practitioners.

During the last few years, the staff at the Infant Welfare Health Center perceived an increase in the number of patients with asthma. At the same time, they found themselves inadequately prepared to provide asthma education and support that was bilingual and culturally sensitive. In 1996, Infant Welfare began to receive asthma-specific funding from two local philanthropic organizations. While one of the awards is primarily dedicated to covering the costs of providing patients with free asthma medications, spacers, and peak flowmeters, both awards have made it possible for Infant Welfare to develop a comprehensive asthma management program. At the start, the funds covered the services of a pediatrician, who dedicated several hours per week to asthma care. However, as the number of patients with asthma continued to rise, it became increasingly difficult for the medical staff to provide appropriate and necessary asthma education. None of the practitioners were fluent in Spanish or understood the cultural sensitivities associated with a chronic illness such as asthma. It soon became clear that they needed additional support staff, and the funds were redirected to cover the cost of a full-time asthma health educator as well as an Americorps member to assist the asthma educator with day-to-day tasks.

The role of the educator is to provide one-on-one comprehensive education for newly diagnosed patients and their caregivers, as well as review of key topics when patients come in for follow-up. The health educator also conducts group classes on Saturday mornings. For patients with more involved asthma, the educator conducts home visits for the purpose of environmental assessment.

One of the most successful activities of the Infant Welfare asthma program to date is the annual Asthma Education Fair. For the past 3 years, this fair has attracted 50 to 150 asthma patients. It is held in November to coincide with the distribution of influenza vaccinations. A flyer is mailed to asthma patients 1 month before the event. To attract attendance, the flyer announces free medications and free flu shots.

On the day of the fair, the entire clinic is closed, and the facility is set up as a series of stations. As patients negotiate the various stations, they receive education about asthma triggers, medications, peak flow monitoring, and inhaler and spacer technique. The children also attend a session on “how to express your feelings,” conducted by a mental health worker. Health-care providers conduct exams, review each patient’s patterns of health-care utilization and asthma action plan, administer flu shots, and distribute asthma medications. The staff provides bilingual written materials for all aspects of asthma education.

Monitoring and Evaluation: The Asthma Task Force

As its asthma management project matures, Infant Welfare has recognized the need for ongoing monitoring and evaluation of its efforts. To date, the center has 450 identified asthma patients. The clinic has set up an Asthma Task Force consisting of medical providers, nurses, and health educators to help guide their improvement efforts. The task force reviews and often revises their patient education materials for appropriateness for populations of low literacy and translation into Spanish. The task force is particularly helpful in addressing the many cultural issues that arise among the diverse Hispanic populations. In a chain of review, patient materials are passed from Colombian staff to Guatemalan staff to Mexican staff, etc, to assure that the final materials will be culturally acceptable to all. Most recently, the Asthma Task Force developed an updated program of six handouts that cover asthma education in an organized and comprehensive way. The entire staff reviewed the program prior to implementation.

The task force is also beginning to understand how to characterize and monitor their asthma patient population. The asthma health educator is responsible for maintaining a database of information on each patient that includes such items as duration of illness, triggers, medications, and health-care utilization. The next challenge is to develop a better system for tracking patient follow-up. The group has put in place a policy of coding for asthma—even when the child comes into the clinic for well-child check-ups or other problems. It is hoped that this will keep the mailing list of asthma patients up to date.

Through comprehensive education and quarterly follow-up, the Asthma Task Force of the Infant Welfare Society hopes to make a significant impact on improving asthma morbidity in the communities they serve.

The Asthma Management Project of the Infant Welfare Society of Chicago is funded by grants from the Otho S.A. Sprague Memorial Institute and the Lloyd A. Fry Foundation.




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