Health Care Costs and Financing

Community health centers need more resources to provide proper care to high-risk asthma patients

Federally funded community health centers (CHCs) care for many poor, high-risk asthma patients. Unfortunately, they often do not have the resources needed to follow current guidelines for optimal asthma care, according to a study supported in part by the Agency for Health Care Policy and Research (interagency agreement with the Bureau of Primary Health Care, Health Resources and Services Administration). For instance, 29 percent of CHCs surveyed in the Southeastern United States were unable to provide needed asthma medications for uninsured asthma patients.

To avoid unnecessary hospitalizations due to uncontrolled asthma, low-income and uninsured asthma patients must have affordable access to recommended treatments such as inhaled steroids, beta-agonist inhalers, and metered-dose inhaler spacing devices, as well as tools such as peak flow meters to measure and monitor their breathing capacity. But only a small proportion of CHCs surveyed could provide these, especially to uninsured children.

Investing in CHCs could improve asthma care and outcomes for as many as a quarter of a million of the highest risk asthma patients in the United States, conclude the authors of the study. They collected data on CHC clinicians, pharmacy services, and patient characteristics from 35 CHCs in 8 Southeastern States during a 1-year period. Sixty-two percent of patients had income below the poverty level, and almost 75 percent were uninsured or receiving Medicaid.

Current national guidelines for the treatment of asthma emphasize early use of antiinflammatory medication, especially steroid inhalers. Underuse of inhaled steroids has been associated with higher asthma hospitalization rates, and overuse of beta-agonist medication has been associated with increased asthma symptoms, morbidity, and death. Of the CHCs that provided medication to patients, 82 percent provided beta-agonist inhalers, but 46 percent provided no steroid inhalers to their patients. Also, 83 percent of CHCs provided no peak flow meters to their asthma patients, and 65 percent were unable to provide simple spacers to maximize the benefit of metered-dose inhalers. Drug samples were the most common resource that clinic sites used to treat low-income asthma patients.

More details are in "Asthma care in community health centers: A study by the Southeast Regional Clinicians' Network," by George S. Rust, M.D., M.P.H., Virgil Murray, B.S., Hector Octaviani, M.D., and others, in the Journal of the National Medical Association 91(7), pp. 398-403, 1999.

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