Responding to Asthma as a public health problem

Partnering to develop and implement a countywide asthma plan to improve the

quality of life for people with asthma

Erica L. Fishman, MSW, MPHKaren A. Monsen, PhD, MS, RN

Debra L. Lee, BA, LSN, PHN

Washington Co. Dept of Public Health and Environment

• The story begins: One public health nurse with a passion for improving the quality of life for people with asthma mobilized a public health department….

Where Does Asthma Fit?

• Asthma is a growing public health concern – but where does it fit in the context of a local public health program?

• It is a disease that crosses many programs: family health nursing, disease prevention and control, elderly and disabled case management, health promotion, environmental health, WIC, EPSDT, and administration.

Who Are Our Partners?

• Centers for Disease Control and Prevention

• Minnesota Department of Health

• American Lung Association

Theoretical Frameworks

• CDC asthma program framework

• Minnesota State Asthma Plan: Strategies for Addressing Asthma in Minnesota

• Public Health Interventions Document

• Public Health Core Functions

CDC components of an asthma program

• Partnerships

• Interventions

• Surveillance

• Communication

• Evaluation

• Sustainability

Program Drivers: Data and disparities

• CDC’s National Asthma Control Program supports the goals and objectives of Healthy People 2010 for asthma: to reduce the number of deaths, hospitalizations, emergency department visits, school or work days missed, and limitations on activity due to asthma

Minnesota Department of Health (MDH) Asthma Program

• Funding from Centers for Disease Control and Prevention (CDC)

• Planning grant awarded October 1999 for 3 years

• Developed state specific strategic plan• Implementation grant awarded October

2002 for 5 years – “Addressing Asthma from a Public Health Perspective”

Minnesota Department of Health Center for Public Health Nursing March 2003

Public Health Intervention Wheel

Core Functions of Public Health

• Assessment

• Policy Development

• Assurance

Core Functions of Public Health

Assessment Activities

• In November of 2005, the Washington County Public Health and Environment Asthma Work Group was formed to define their department’s role in responding to asthma as a public health problem

• Comprised of representative from each Department team

• Also included representation of the Minnesota Department of Health Asthma Program and the Metro Asthma Coalition

Gaps Identified and Addressed

• Gaps identified in areas of general knowledge, health practitioner knowledge, community resources available, and environmental assessment capacity.

• The department addressed these gaps using existing environmental health staff, community health staff, and allocation of "seed" funding

Policy Development Activities

Engaging Partners

• The efforts of the Department in turn engaged a broad and expanding network of partners to participate in disseminating best practices for asthma management, and leveraged additional resources from public and private entities to expand the reach of these efforts.

Coalition Partners

• Department environmental and community health staff, • school nurses from five school districts, • Lakeview Hospital Physicians, • Pediatric Home Services, • Minnesota Department of Health, • Minnesota Asthma Coalition, • East Central Minnesota Asthma Coalition, • Minnesota Environmental Initiative-Project Green Fleet, • WIC, • EPSDT staff, • people with asthma or their family members

Public Awareness

• Public Service Announcements

• Webpage

• Worksite Health Promotion flyers

• Displays –specific to audience

Assurance Activities

• Provided training to 65 staff from community and environmental health to ensure a basic understanding of asthma and environmental factors

• A certified asthma educator (AE-C) who is skilled at providing home environmental assessments conducted an all-staff in-service

Training the Workforce

Managing Asthma in Minnesota School Personnel Trainings

• For school nurses, health assistants, or anyone providing asthma care to students

www.winningwithasthma.org

• Promoted online asthma training to 500 coaches with Minnesota Department of Health tracking and conducting evaluation

Professional Education

• In collaboration with Minnesota Asthma Coalition and American Lung Association of Upper Midwest held a “Asthma for Busy Pharmacist” training

• Met with local physicians to make aware of the initiative

• Provided information on asthma at provider meetings

Child Care Trainings

• Presentations to day care and foster care providers by University of Minnesota and Bethel University nursing students.

Environmental Interventions

• Home visits, environmental assessments, asthma action plan promotion and products to families in need; supplies and education to school nurses

Indoor Air Quality Management Plan

• State law requires school districts to develop Indoor Air Quality (IAQ) Management plans.

• IAQ training for Environmental Health Staff• Training and technical assistance to

school districts• Environmental Walkthroughs of all school

buildings to identify potential asthma triggers

Retrofitting School Buses

• Minnesota Environmental Initiative’s (MEI) Project Green Fleet retrofitting school buses to reduce diesel emissions

• 23 school buses to be retrofitted South Washington County MN School District #833

• Blue Cross Blue Shield grant to retrofit Headstart buses

• Plans to retrofit County trucks and heavy equipment

Evaluation

• Positive Health Outcomes: One of the goals of the project is to develop a method to use the Omaha system to measure community based asthma initiatives. The Omaha System is a research-based, comprehensive and standardized taxonomy designed to enhance practice, documentation, and information management.

• The home intervention component will be evaluated by collecting baseline and post intervention data on a variety of factors including hospitalizations, emergency department visits, missed school days and Quality of Life indicators.

Moving forward

• A hopeful ending to our story: School nurses, coaches, day care providers, and families report that we’re Catching Our Breath now, in Washington County, Minnesota

For more information

Erica FishmanMinnesota Department ofHealth Asthma Program Golden Rule Building85 East 7th PlaceP.O. Box 64882Saint Paul, MN 55164-0882651-201-5899• e

rica.fishman@health.state.mn.us

• http://www.health.state.mn.us/asthma

Karen MonsenWashington County PublicHealth and Environment14949 62nd St. N.Stillwater, MN 55082-

0006651-430-6697 • karen.monsen@co.was

hington.mn.us • http://

www.co.washington.mn.us/info_for_residents/public_health