 Edward Schuurman, P.A.-C., examines Kristy Thomas, who can breathe more freely since she began getting care at Mont Alto Family Practice in Pennyslvania. Physician assistants and other staff members played key roles in the teams of the Asthma Learning Collaborative. |
BY J.M. BRODIE
Online-only content
Kristy Thomas is breathing a lot easier these days. "I have a lot more control over my breathing than I did before," says the 10-year-old with asthma, smiling after seeing a favorable reading on her peak flow meter.
She's making one of her regular visits to the Mont Alto Family Practice in south central Pennsylvania.
Mont Alto is a picture postcard of bucolic bliss, dotted by lush trees, ripe fields and vast farmland. It is also a haven for pollen and other allergens. It's a place where children with asthma have a hard time.
"Kristy was like most asthma patients we get. The first time we see them, they are in crisis," says Edward Schuurman, P.A.-C. He works in the Mont Alto offices of FPs Greg Lyon-Loftus, M.D., Ph.D., and Diana Lyon-Loftus, M.D., husband and wife.
Two hours to the east in Philadelphia, urban grime, car exhaust and industrial fallout pose serious challenges to people with asthma. FP Elaine Reed, M.D., tucked in her basement office, gets an update from Barnard College student Randie Welles, 17, on how she's dealing with her asthma and allergies. Welles tells the doctor she has been under the weather lately and admits she hasn't kept up on her medications. Without scolding, Reed convinces her to be more diligent in monitoring her own care.
"Randie is not like a lot of my patients because I can go into more detail about her illness," Reed says after the visit. She peers out from behind a stack of patient folders in the converted home, now a clinic -- Penn Care University City Family Medicine, a part of the University of Pennsylvania's health system -- just blocks away from downtown and the university. "For most, I have to boil things down to the very basics. The patients we serve here are, for the most part, very poor and not as well-educated," says Reed.
In both practices, the physicians and their assistants struggle to get patients to be more proactive in coping with their illnesses. A large percentage of patients in both areas have allergies. The physicians see the asthma problem getting worse. They ask patients to reverse the trend of waiting to seek medical help until they have severe attacks.
Tap into resources on asthmaTeams within AAFP's Asthma Learning Collaborative have posted their team stories and contact information at http://www.aafp.org/x3857.xml. Feel free to ask the participants for tips on caring for patients with asthma. Other help is on the way: The Academy is planning a late 2003 rollout of print and online versions of the Asthma & Allergy Resource Guide, a collection of tips and tools for use in everyday family practice. And if you're attending the AAFP Annual Assembly in New Orleans, you may want to take this Oct. 3 course: "Improving Chronic Illness Care in Family Practice: Lessons From the AAFP Asthma Collaborative." |
The physicians have sought out new methods and procedures.
Their search led them to AAFP's Asthma Learning Collaborative, a yearlong project that began in May 2002 with a meeting in Kansas City, Mo. The collaborative was organized by the AAFP and the National Initiative for Children's Healthcare Quality. Asthma, one of the most prevalent chronic diseases in the world, is especially common among children.
Physicians, physician assistants (including Schuurman) and other office staff members from 13 family practice centers -- serving about 150,000 patients -- took part in three one-and-a-half-day sessions to learn ways to measurably improve the care they give children with asthma. The project was supported by an educational grant from Schering Pharmaceuticals.
"There are a lot of practices that are eager to improve asthma care, and bringing a team to the collaborative was really important," says Barbara Yawn, M.D., of Rochester, Minn., past chair of the AAFP Commission on Clinical Policies and Research and a faculty member for the project. "You can't implement change when it is just the physicians who are doing it."
The collaborative focused on improving the systems that support quality asthma care in a variety of family practice settings. Participants used tools such as a registry of patients with asthma and a process for ensuring that the severity of asthma was assessed for each of those patients at every visit.
Reed came away from the collaborative with an array of new forms she could use to monitor patient visits and get patients more involved in their own care.
Diana Lyon-Loftus gained a better sense of how the Mont Alto health care professionals were doing from sharing ideas and best practices with colleagues across the country. "It let us know that we were doing some things right," she says.
"As family physicians, we are in a unique position to play a key role in providing asthma care, and the collaborative empowered us with the tools to provide that care," says Greg Lyon-Loftus.
All Kristy Thomas knows is the air seems a lot clearer.
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.