Wheezing. Breathlessness. Chest tightness. Coughing. As a registered nurse at Bruce Elementary School in Houston’s Fifth Ward, Paul Rademacher regularly treats students struggling with asthma symptoms. That’s not all they struggle with. More than 96 percent of the children there qualify for free or reduced lunch. It’s no coincidence. Asthma disproportionately affects low-income populations.
Asthma accounts for more than 14 million school days missed nationwide every year, making it the most common childhood medical condition. For families living in poverty, asthma rates skyrocket by 50 percent. Dust, mold, and cockroach and rodent droppings are all common triggers. Lapses in insurance coverage and limited transportation options also contribute to noncompliance, which is when a patient doesn’t take a prescribed medication. Some studies indicate noncompliance can be as high as 70 percent among kids with asthma.
“It’s common for my students to not have any asthma medication,” he said. “Asthma is potentially life threatening, and sometimes it’s challenging for parents to understand that.”
Too often people wind up in emergency rooms being treated for asthma—5,000 ER visits every day in the United States. That’s a total annual cost of over $50 billion for a disease that with proper preventive treatment should rarely, if ever, require hospital visits.
In a new effort to boost inexpensive preventive care and lessen expensive emergency care, UH Honors College professor Dan Price and the Houston Health Department are exploring ways to intervene earlier with at-risk kids. The answer? School nurses. Bruce Elementary is one of five Houston Independent School District schools taking part in a two-year pilot study involving approximately 60 students.
Trusted nurses like Rademacher identify children in need and personally connect them with community health workers (CHW). Most of the CHWs are trained in Price’s certification class, which is open to the community and held at a Third Ward public housing complex. With the family’s consent, the community health workers visit the homes once a month for six months to identify triggers and work together with the families to find solutions.
“Parents often need an advocate to help them understand the best ways of addressing the asthma without just being told by a doctor you have to do X, Y and Z. It’s empowering for them to be part of the problem solving,” said Price.
Community health workers like Raphaneal Anderson receive valuable information about the student’s family dynamics from their school nurse before their first visit to make developing a relationship with the family easier.
“We’re embedded and invested in these communities because we live here too,” she said. “These people know us. They don’t see us as a doctor telling them what to do. We’re the liaison for whatever help they might need.”
Beginning with this asthma intervention, Price and his partners are presenting their findings to insurance companies, hoping to develop better funding models for preventive care. He believes the savings could be significant.
“Because the health care system saves money overall, opportunities to get payers to engage earlier and more effectively can help everyone,” he said.