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Am Fam Physician. 2003;68(7):1415

Asthma is a leading medical cause of school absenteeism and the most common chronic illness affecting children in the United States. Asthma treatment requires strict adherence to medical regimens, and poor compliance results in frequent emergency department visits or hospitalizations. The number of school-based health centers has increased in the past decade. These centers are designed to provide primary, preventive, and acute care for school-aged children, as well as to treat chronic conditions. Recently, questions about the effectiveness of this system have been raised. Some studies have examined the cost-effectiveness of these health centers, but none using a quasi-experimental design has studied outcomes. Webber and colleagues examined the outcomes of children with asthma, comparing the results of those with and without access to school-based health centers.

Study participants were children who attended six different elementary schools in Bronx, N.Y., and had been diagnosed with asthma. Four of the elementary schools had school-based health centers while the other two had a traditional school nurse. Survey instruments were sent to the children's homes collect data. At least three attempts were made to obtain survey responses from parents. Information collected included demographic data, whether the child had asthma and, if so, which asthma symptoms were present. The survey also asked questions concerning emergency department visits, hospitalizations, and medication use during the past year. In addition, absenteeism data were collected from five of the six schools.

Of the 6,433 families surveyed for the study, 74.2 percent responded. The prevalence of asthma in this group was 19.9 percent (949 children). During the previous year, 46.2 percent (438 children) were treated in the emergency department for asthma and 12.6 percent (120 children) required hospitalization. Children with asthma who attended schools with school-based health centers had lower rates of hospitalization and missed significantly fewer days of school than children who did not have access to these health centers. The average decrease in absenteeism related to asthma was three days in the children who had access to school-based health centers. No difference was noted between the two groups in the use of emergency departments for asthma treatment.

The authors conclude that school-based health centers have a positive impact on the health of children with asthma. They note that these centers can reduce asthma-related rates of hospitalization and improve school attendance.

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