Nurse-mediated Change

Four or five visits per year with a trained asthma nurse who conducts assessments are planned for asthma patients and family members.

Nurse activities (patient visits, etc.) include:

• Assessment of asthma symptoms, medication use, environmental control, and self-management skills. (The nurse shares a computer-generated report of findings with the child's physician.)
• Self-management support to families regarding medication adherence, technical skills, and environmental triggers, using problem-solving and motivational techniques.
• Proactive standardized telephone followup between visits.
• Support and participation in care planning (including medication and environmental measures) in conjunction with primary care providers, using the Expert Panel Report-2 (EPR-2), with emphasis on the use of controllers for persistent disease.
• Arranging for allergists to visit the primary care site for case discussions.
• Other activities including reviewing with physicians quarterly registry-based asthma panel reports (on medication use and emergency department visits).

Asthma nurse training includes:

• Training in NAEPP's EPR-2 and in self-management support techniques.
• Full-day training session to learn motivational enhancement and problem-solving techniques.
• Meetings weekly or every other week for 10 weeks for 1-hour conference calls to review written materials.

Peer Leader Education

One primary care provider per practice is trained in asthma guidelines and peer teaching methods.

Training emphasizes asthma pharmacotherapy and physician behavior change strategies.

Training includes two workshops, central support by an educational coordinator, and an ongoing learning network for peer leaders via national and local teleconferences.

Peer leader education provides ongoing support for physicians in their role as change agents.