Working Toward a Sustainable System of Asthma Care: Development of the School-Based Preventive Asthma Care Technology (SB-PACT) Trial

Abstract

Objective We previously conducted the School Based Asthma Therapy trial to improve adherence to national asthma guidelines for urban children through directly observed administration of preventive asthma medications in school. The trial successfully improved outcomes among these children; however several factors limit its potential for dissemination. To enhance sustainability, we subsequently developed a new model of care using web-based guides for efficient communications and integration within school and community systems. This paper describes the development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. Method We developed the SB-PACT web-based system based on stakeholder feedback, and conducted a pilot randomized trial with 100 children to establish its feasibility in facilitating preventive asthma care for high-risk children. The SB-PACT system represents a new model of care using web-based guides for asthma symptom screening, follow-up control assessments, and electronic communications with providers. Result We enrolled and successfully screened all children using the web-based system. Most providers used the electronic communication system without difficulty, and the majority of children in the intervention group received preventive medications through school as planned and dose adjustments as needed. Several challenges to implementation also were encountered. Conclusion This program is designed to promote sustainability of school-based asthma care, reduce program costs, and to ultimately succeed in a real-world setting. With further refinements, it has the potential to be implemented nationally in schools.

Stakeholder Perspectives on Optimizing Communication in a School‐Centered Asthma Program

“…Although SAPs have demonstrated positive clinical outcomes, these programs encounter challenges related to sustainability and dissemination, including a lack of standardized outcome measures, an overreliance on outside organizations, and resource barriers . Furthermore, schools and PCPs often do not function together effectively in SAPs, with both groups acting independently without much coordination and communication .…”

The School-Based Preventive Asthma Care Trial: Results of a Pilot Study

“…We found that many of the barriers in the original study were overcome with a web-based mechanism for asthma screening, control monitoring, report generation, and medication authorization. Although some challenges in implementation were encountered, 11 in general we found the system to be feasible and efficient. Caregivers, providers, and school health staff expressed general satisfaction with the program and the majority stated that this program should continue within the school district.…”

Cost-Effectiveness of the School-Based Asthma Therapy (SBAT) Program

“…Further, the original study included an additional home-based smoke reduction component that was not included in the cost analysis or subsequent SBAT studies. 51 This decision was made based on our primary analysis that demonstrated that the improvement in asthma symptoms in the treatment group was independent of children' s cotinine level. 27,51 We did, however, control for family smoking status in all analyses.…”