CALM Story – Reduced Barriers to Asthma Action Plans

In August 2009, the Institute for Family Medicine was fortunate to receive an important “Childhood Asthma Linkages across Missouri” grant from Missouri Foundation for Health.  We have titled the program “School Based Asthma Management – Breaking Down the Barriers”.  It is implemented exclusively in the St Louis Public Schools, and has three components.  The components include working with school nurses to asthma management at school, bringing family friendly asthma education programs into the community, and talking to primary care physicians about the importance of working with school nurses.  We are currently in our final year of implementation, so we are back at the program to learn more about what worked and what the challenges were.  Below is a story about a program success:


A key objective of the “School Based Asthma Management – Breaking Down the Barriers” project is to increase the number of students with asthma for whom the school nurse has complete information on file.  Desired information includes the name of the child’s physician, as well as an Asthma Action Plan.  An Asthma Action Plan (AAP) is an easy to understand guideline for treatment written for the child by the primary care physician.  It is important for school nurses to have an AAP on file for her asthmatic students so that, in a case that the student can’t breathe, she knows how to treat the child.  An AAP has the potential to help save a child’s life, or at least get them back to class after an asthma attack, rather than in an ambulance on the way to the ER.


As project lead, the Institute for Family Medicine talks to primary care physicians about their experience with working with school nurses.  We know from those conversations and from data from insurance companies that physicians are writing these Asthma Action Plans – a majority of children had had an AAP written on their behalf.  However, we also know from data from the school nurses that they only have AAPs on file for a very small percentage of students.  So our question was why weren’t these plans getting to the school nurse and what could we do to improve that?


So we talked again to the primary care physicians and their offices.  They felt that they lacked parental consent to fax the AAP to the school nurse (in order to be HIPAA compliant).  Our solution was to create a mini consent form – so small that it could fit on a sticker the size of a mailing label.  That mini consent form made it easy for the physician to get the parent’s signature and stick it directly to the action plan.


Recently, one of our partners in this project sponsored a new printing of the Asthma Action Plan that included the mini consent on the front page, along with the Institute for Family Medicine logo.  Now, that is sustainability!

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