Winning over the difficult asthma client
Develop an asthma program that works
What good is an asthma prevention and education program that can reduce costs if patients refuse to participate and if those who do don’t like the field staff? None. But the Visiting Nurse Association of Greater Philadelphia created a program last October that is showing remarkable initial results.
The program has a high retention rate among a group of patients mostly Medicaid patients who are not usually interested in such programs, says Lynne Rinke, RN, MS, executive vice president and chief operating officer of the agency. Although patient satisfaction surveys are still pending, Rinke says word of mouth is that patients appreciate a program that empowers them to have more control over their illness.
Debbi Davis, RN, maternal-child coordinator at NorthBay Health at Home in Fairfield, CA, has developed a similar program that is also showing positive outcomes. The two offer these six tips for those thinking of embarking on such a project:
1. Find a physician champion.
Rinke says a physician leader who is a recognized authority on asthma in your area can help sell the idea to payers and physicians. "This only works if doctors are capitated and have a financial risk. If they are, they are willing to hop on the bandwagon."
2. Develop materials that apply to all patients.
Half the patients you have will be adults, says Rinke, and your materials should reflect that split. Treating young children means dealing with parents and siblings. Davis says that can be one of the hardest aspects of pediatric asthma: convincing parents that their child’s health depends on them not smoking in the house, on getting rid of the family pet, or on finding time to vacuum and dust when the child is not in the home.
3. Ask payers what they need.
Rinke says payers all know asthma is a problem. But if you deal with more than one payer, recognize that they may have different reporting requirements and be ready to tailor your reports to their needs. Some payers might want data on outcomes related to the age of the patient, she says, while others might want quality-of-life surveys done at regular intervals.
4. Make sure your staff is adequately trained.
Davis says another benefit of a physician champion is his or her ability to teach your nurses about asthma. Her program included eight hours of inservice on treatments, on how to use a peak flow meter to measure lung capacity the No. 1 indicator of an impending attack the triggers for attacks, and the physiology of the illness.
5. Be willing to ask for specialists.
Few family doctors have expertise in the newest treatments for asthma, says Davis. She recommends that all referred patients see a specialist so an appropriate treatment plan can be developed. "Most asthma exacerbation results from improper treatment," she says. "Getting the right medication and the right equipment is vital."
6. Read, read, read.
There is plenty of literature on asthma, but Davis says it is more important to search for works on outpatient and home care of the disease. That will give you more insight into what educational programs are out there, she says.
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