There is a significant issue with the rates of emergency department visits among children with asthma that calls for the creation of an intervention plan. According to Dannefer et al. (2019), the rates of morbidity and mortality are disproportionately high in “the South Bronx, East and Central Harlem, and North and Central Brooklyn” (p. 163). It implies the need to study what factors lead to this disparity and how new healthcare initiatives can alleviate it. The population of Central Harlem will be the target of this intervention that aims to decrease the rate of children’s asthma-related ED visits. The primary causes for this health problem will be reviewed to identify the actions necessary for its resolution. This essay overviews the factors contributing to this health issue and the intervention plan that aims to alleviate it among the target population.
The objective of this intervention is to reduce child asthma emergency department visits in Central Harlem. Asthma remains one of the critical issues in underrepresented communities with low income, such as the population of the chosen area, with rates of occurrence being as high as 20-30% (Louisias & Phipatanakul, 2017). To alleviate this disparity, the intervention plan will consist of increased attention to this health issue and promotion of an efficient and sustainable treatment method.
The choice of intervention methods is modeled after contemporary research on reducing the effects of asthma in children. The studies show that an asthma medication regimen that consists of proper use of a long-term controller has five times lower rates of asthma ED visits (Baltrus et al., 2016). Compliance with proposed treatment that uses long-term controller medication regimens is one of the crucial sources of alleviation of this health issue (Baltrus et al., 2016). Therefore, the intervention plan will focus on the promotion of this regimen among the target population. This promotion will take place over a three months period, during which the public health campaign will connect healthcare providers with the target population.
To achieve the desired effect, healthcare organizations that operate in this area, both public and private, will be included in the public health initiative that focuses on family education. Louisias and Phipatanakul (2017) state that the primary sources of improvement are “dealing with reducing/eliminating allergen or pollutant exposure, educational and empowerment support for patients, and decision support tools and resources for providers” (p. 68). A significant portion of the intervention’s desired effect will be achieved by teaching parents and their children how to recognize and eliminate the substances that can trigger asthma. Healthcare providers in the area will help with the distribution of this information via short educational courses, pamphlets, and advertisements.
The particular population of Central Harlem presents a critical issue for several reasons that must be acknowledged in the intervention. There is a limitation on the scope of the intervention. The barriers to access are especially prominent in the population who only have Medicaid insurance in contrast to those patients who have private insurance plans (Baltrus et al., 2016). The resources of the health care system are unequally distributed among these populations, leading to a decreased, to the point of unsatisfactory, quality of primary care.
The recent studies have revealed that the low-income household status alone is not linked directly to the increased risk of asthma in children, and the causes are multifactorial (Louisias & Phipatanakul, 2017). They combine poor housing materials that can work as allergens or air pollutants, race/ethnicity, behavioral factors, such as smoking and obesity, mixed with a low socioeconomic status of a household (Louisias & Phipatanakul, 2017). Therefore, not all residents of the target area are in the scope of the intervention.
The primary stakeholders for this implementation plan must be outlined to define their roles and the value of this intervention. The primary stakeholders are the children with asthma and their families in Central Harlem. Healthcare centers that operate in that area are the second stakeholders due to the proposed public health initiative. The healthcare system can benefit greatly from an efficient implementation of this intervention, decreasing the number of ED visits. Insurance companies can be involved in this process to incentivize the usage of long-term asthma controllers, making them a potential stakeholder in this initiative.
Table 1. The Intervention plan SWOT analysis.
Aside from the goal recognition and the assessment of the scope of the plan, an implementation plan can benefit significantly from the analysis of external and internal factors. It can reveal several vital prospects that need to be addressed by the intervention, as well as prepare the layout of its future expansions. This SWOT analysis, for example, shows a definite need to focus on the improvement of the basis created by other studies that have already developed their approaches to the target population. However, it also reveals that none of the existing programs have been able to eliminate the adverse impact of social determinants of health.
According to Kwok et al. (2018), the most prominent barriers to the implementation of an efficient intervention program are the lacking “access to PCPs, insurance status, transportation availability, and telephone access” (p. 637). Therefore, the additional focus must be placed on people who are disproportionately affected by the root causes of this health issue.
Table 2. The responsibility chart for the proposed intervention.
In conclusion, this intervention plan creates an opportunity for healthcare providers to cooperate with the target population in an attempt to increase compliance rates with the long-term controller usage regimen. The effectiveness of such an initiative has been proven in the past by programs that focused on family education among underrepresented communities. Baltrus et al. (2016) state that the “Harlem Children’s Zone initiative has reduced asthma ED visits among predominantly Black children in low-income neighborhoods by 77%” (p. 59). The expected outcome of this intervention is the decreased rate of emergency department visits due to an increased usage of long-term controller medications. To control the intervention results, it is necessary to compare the number of child asthma-related ED visits before and after the education courses.
References
Baltrus, P., Xu, J., Immergluck, L., Gaglioti, A., Adesokan, A., & Rust, G. (2016). Individual and County level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach. Journal of Asthma, 54(1), 53-61. Web.
Dannefer, R., Wong, B. C., John, P., Gutierrez, J., Brown-Dudley, L., Freeman, K., Roberts, C., Martins, E., Napier, E., Noyes, P., Seoh, H., Bedell, J., Toner, C., Easterling, T., Lopez, J., Manyindo, N., & Maybank, K. A. (2019). The neighborhood as a unit of change for health: Early findings from the East Harlem neighborhood health action center. Journal of Community Health, 45(1), 161-169. Web.
Kwok, M. Y., Pusic, M. V., Cabrera, K. I., York, D. V., Lee, J., & Evans, D. (2018). Asthma-related educational needs of families with children with asthma in an urban pediatric emergency department. Pediatric Emergency Care, 34(9), 636-640. Web.
Louisias, M., & Phipatanakul, W. (2017). Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: Closing the gap. Current Allergy and Asthma Reports, 17(10). Web.