Using School Partnerships to Advance Care for Asthma, Food Allergy, and Anaphylaxis

When Robert Lemanske Jr., MD, of the University of Wisconsin, was president of AAAAI in 2015, he lamented the lack of communication among families, clinicians, and school nurses regarding schoolchildren with asthma. He wished children would have access during school to medications such as rescue inhalers, and he hoped to address patients’ exposure to irritants in the school environment. In the United States, 6.8 million children (9.3%) have asthma, Dr. Lemanske said, and they miss school three times as much as healthy kids.

He launched an initiative in 2016 to help children with asthma better manage their disease by leveraging the school system, as well as miss fewer days of school. At the 2018 AAAAI Annual Meeting, he and his colleagues shared the development of SAMPRO™: A School-Based Asthma and Allergy Management Program, which began in September 2016 as a collaboration between AAAAI and the National Association of School Nurses. The program is largely based at the University of Wisconsin and has four components:

• A “circle of support” that facilitates communications among clinicians, school nurses, families, and the community
• Detailed asthma-management plans, including action plans and emergency plans
• A comprehensive education plan for all school personnel
• A plan for assessment of the school environment regarding asthma triggers

An Actionable Action Plan

Sujani Kakumanu, MD, also of the University of Wisconsin, described the evolution of SAMPRO: The team reviewed and revised an existing action plan form—and realized some things were missing, including designation of asthma severity and risk of exacerbation. In addition to updating the form to include that information, the team worked with developers to incorporate the form into the electronic medical record (EMR), focusing on requiring a minimal amount of clicking and searching, so practitioners would use it in a normal clinical workflow.

Originally, the form had to be printed and given to the patient to take it to school, but the team decided to make it transmittable electronically between University of Wisconsin Heath and health personnel within the Madison Metropolitan School District. This allows school nurses to view action plans, progress notes, hospital discharge summaries, and medication orders—and also send direct, secure messages to clinicians.

“The child’s EMR is accessible to the school nurse, so they can manage asthma based on the most up-to-date action plan,” Dr. Kakumanu said.

SAMPRO has been successful thus far, said Drs. Lemanske and Kakumanu, recruiting more than 100 children and 32 nurses at nine sites. Moreover, the team has documented 20% to 70% increases in completion of asthma action plans.

They outlined plans to expand beyond asthma to address anaphylaxis and food allergy. In fact, AAAAI has begun a collaboration with the American Academy of Pediatrics to develop an anaphylaxis action plan. Other next steps include working on related legislation, such as the Emergency Epinephrine Act, the School-Based Respiratory Health Management Act, and state laws to get albuterol stocked in schools. Additionally, the team is exploring the possibility of introducing the SAMPRO program in the Chicago Public School System.

Information about SAMPRO, including the toolkit, can be found at aaaai.org/SAMPRO.

How Allergists Can Work with Schools

Melanie Gleason, MS, PA-C, of the Breathing Institute in Colorado, offered tips for healthcare professionals outside the SAMPRO network who are seeking to collaborate with schools to improve asthma care.

She was involved in developing a Colorado program, similar to SAMPRO: Building Bridges for Asthma Care. The program’s team members meet with children three to four times per year at school to perform asthma control tests, evaluate inhaler technique with a checklist, and provide asthma education. The program has increased the availability of school asthma care plans from 5% to 85%, increased the number of registered nurses certified as asthma educators, improved asthma self-care skills, reduced asthma burden, and improved school attendance. This year, it is expanding from five school districts to 10, as well as working to get into the EMR system.

She offered the following tips for healthcare providers who would like to work with their patients’ schools:

• Communicate! “The Health Insurance Portability and Accountability Act and the Family Educational Rights and Privacy Act are not barriers to communication,” she said.
• Realize that school nurses are a vital part of the team.
• Identify and document school nurses, and develop school nurse contact lists.
• Complete and update school forms. They must be written precisely, because tasks are often delegated to non-health school personnel.
• Ensure every child has a quick relief inhaler and a spacer.
• Turn the absence “excuse” into a useful letter addressed to the school nurse.
• Investigate what resources exist at your local schools, build relationships, provide resources like those available through SAMPRO, and know your state laws.
• Post reminders in clinics to remind clinicians to talk about asthma care in school.

Presentation 1301: Bridging the Care Gap: Using School Partnerships to Advance Care for Asthma, Food Allergy and Anaphylaxis