Abstract Childhood asthma affected an estimated 5 million children under the age of 15 during the year of 1995. The diagnosis of this disease is on a continual rise in the United States, and it is the responsibility of all health care providers to busy themselves in providing the proper patient education, treatment, and preventative measures available to prevent unnecessary suffering caused by asthma (Improving Childhood Asthma, n. d. ).
Throughout the next few pages the following essential issues will be: defining more closely this patient population, identifying organizations that provide care for this population, discussing methods in which this care is financed, and finally suggesting mechanisms in which nursing can impact this health care delivery model. Addressing the aforementioned essential issues concerning childhood asthma will provide the necessary knowledge to health care providers treating this monster childhood disease.
Identification of the patient population being served The patient population focus for this paper will be children with asthma. This chronic lung disease, grouped into the COPD class of diseases, affects an estimated 5 million children every year (Improving Childhood Asthma, n. d. ). “Asthma is a growing health problem in the United States, particularly in inner-city African-American and Latino populations” (Asthma: A Concern for Minority, 2001). The death rate for these inner-city patients is three times that of whites.
Noted as contributing factors to the increase in death rates are: low socioeconomic status, lack of access to medical care, substandard housing that increases exposure to certain indoor allergens, lack of education, and the failure to take prescription medicine appropriately (Asthma: A Concern for Minority, 2001). Health care providers involved in the care of this specific patient population must focus on the contributing factors yielding vulnerability to this group.
A focused approach to the treatment of childhood asthma should not exclude from the affected patient population but instead be used as a guide to provide appropriate and effective care to any noted high risk patient. Specific symptoms of an asthmatic attack can include chest tightness, wheezing, coughing, and a sensation of shortness of breath. These symptoms are often precipitated by various triggers; including but not limited to viral respiratory infections, exposure to allergens (such as house dust mites and cockroaches), exposure to airway irritants, and exercise.
Under normal circumstances environmental modifications along with the proper use of inhalers asthma sufferers can control, if not prevent, attacks (Asthma: A Concern for Minority, 2001). Organizations that comprise the health care delivery system “Childhood asthma is a national public health problem that challenges not only the entire health system but also school systems and the many public and private organizations that track the effects of this illness, provide education and other community-based programs, and fund research into the causes of asthma” (Improving Childhood Asthma, n.d.).
Considering the multi-faceted health care delivery system for the childhood asthma patient, improvement of care will require resources, research, time, and implementation from all of these various organizations. The national government contributes resources that are more monetarily focused and will be discussed in more detail later. Despite the many resources the national government provides, the majority of the health care delivery system for the child with asthma falls on the backs of state and local governments.
Under Federal Law, hospitals can not turn away basic care to any patient regardless of the ability to pay for services provided. Hospitals funded by the state, privately owned hospitals, and local [county owned] hospitals all provide emergency and in-house care to the childhood asthma patient (Buescher & Jones-Vessey, 1999). Ideal delivery systems also include a primary care clinic, or physicians office who provide continuous managed care for these vulnerable individual.
Unfortunately, due to the socioeconomic factors surrounding childhood asthma many patients’ caregivers find only one main deliverer of care, the emergency department. Remembering that this disease affects more inner-city low-income black and Latino children; these very families have little or no health insurance leading to more emergency room visits than whites with the same disease process (Summer, 2001). Mechanisms for financing care For the 1996 year $4,604,534,917 were spent on health care for children with asthma. “Almost one third of children with asthma are covered under Medicaid.
Medicaid beneficiaries use health services differently than individuals covered under commercial insurance. Children covered under Medicaid are more likely to use hospital-based health services, while children with private insurance tend to make more office-based visits and use more prescribed drugs to treat their asthma” (Summer, 2001). Despite this huge contribution by the national and state governments provided by the Medicare program, more than one fifth of the health care provided to children with asthma is paid out-of-pocket.
Private insurance companies provide the most financial expenditure concerning childhood asthma at fifty percent (Summer, 2001). Pharmaceutical companies, such as GlaxoSmithKline, provide free samples, or discounted rates for individuals based on a need basis (Sign up for the Breathe, n. d. ) Private organizations and the aforementioned pharmaceuticals provide a mere three percent of the overall costs associated with the health care provided to asthmatic children. With changes in health care, namely the evolution of managed care, Medicare will eventually provide more efficient health care to its constituents.
Future reports by the Center for Health Care Strategies on childhood asthma will hopefully reflect this shift to managed care with less emergency room visits and increased primary care visits. A predicted 56% of Medicare recipients were expected to be enrolled under managed care by the year 2000; today this number should be in the eighty percentile (Summer, 2001). With cost cited as the major hindrance “? families of more than half a million children with asthma indicate that their children had difficulty obtaining health care services” (Summer, 2001).
Role of government The national and state governments collectively provide the monetary assistance, through Medicaid, necessary to provide effective treatment of childhood asthma. Financial contribution alone can not alleviate the impact that asthma impels on society, the future treatment of this disease depends on policy changes and education campaigns. “In 1999, the Robert Wood Johnson Foundation funded RAND Health to outline directions for childhood asthma policy in the United States” (Improving Childhood Asthma, n. d. ).
This panel identified six policy goals, with eleven actual policy change or addition suggestions, all with the common objective to develop and maintain asthma-friendly communities. Within each community asthma would be quickly identified, and treated. Policy goals included: ensuring asthma free schools, promoting asthma-free home environment, improve asthma awareness, improve access and quality of asthma health care services, and encourage asthma prevention (Improving Childhood Asthma, n. d. ). Individual states institute initiatives that provide focused attention to childhood asthma.
North Carolina’s State Health Director, in 1998, recognized “? the high potential for preventing asthma-related problems among children? ” (Buescher & Jones-Vessey, 1999) and established the North Carolina Childhood Asthma Initiative. The initiative addresses four groups vital to the care of the asthma patient: medical management, environment, education, and epidemiology (Buescher & Jones-Vessey, 1999). Private organizations also contribute in the research and development of policy as with the “Improving Asthma Care for Children program, a $3.
25 million, four-year national initiative, is funding five collaborative efforts to improve the management of pediatric asthma in high-risk recipients of Medicaid and State Children’s Health Insurance Programs” (Barta, 2002). Mechanisms for nursing impact on this model of delivery “In 1996, five percent of the nation’s children had asthma; the number is projected to rise to 14 percent by 2020” (Summer, 2001). Nationally, in 1995, there were 1. 8 million emergency room visits, and 451,000 hospitalizations all related to asthma.
Children account for approximately one third of these visits and hospitalizations (Asthma: A Concern for Minority, 2001). In the state of North Carolina, for the 1998 Medicaid fiscal year, reports indicate that 13% of children had an indication of asthma with more than $23,000,000 paid out for their asthma related health care services (Buescher & Jones-Vessey, 1999). With all statistics on treatment of asthma it only makes sense that it is the leading cause of school absenteeism (Asthma: A Concern for Minority, 2001).
Also, education of patients and care-providers is desperately needed as research shows that “most children with asthma tend to use medications inappropriately, if at all” (Summer, 2001). The model of health care delivery for the child with asthma covers the full gamete from federal, state, local, and private organizations all taking a part in providing for this vulnerable diseased population. Nurses have the opportunity to assist in molding this model into a more efficient and effective system at every level.
On the national level politically aware graduate nurses could provide a great impact on policy changes like those introduced by RAND Health. On the state level nurses could become involved with changing Medicare policy towards a managed care system (as is already happening), or working with the education department in determining and correcting factors that trigger asthma at school. Finally, on the local level nurses that provide primary care (either in the clinic or the emergency department) or work in a case management role can educate patients and families on asthma prevention, triggers, and effective treatment options available.
References Asthma: A Concern for Minority Populations (pp. 1-6). (2001, October). Bethesda, Maryland: National Institute of Allergy and Infection Diseases. Barta, P. J. (2002, November). Achieving Better Care for Asthma (pp. 1-7). Lawrenceville, NJ: Center for Health Care Strategies, Inc. Buescher, P. , & Jones-Vessey, K. (1999, March). Childhood Asthma in North Carolina. SCHS Studies (113, pp. 1-10). North Carolina: Department of Health and Human Services. Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action. (n. d. ). Executive Summary (pp.
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