Improving Access to Asthma Medications in Schools:Laws, policies, practices and recommendations

Katherine PruittOctober 16, 2014

The Increasing Access to Asthma Medications in Schools project is supported in full by Cooperative Agreement #U38OT000224 from the Centers for Disease Control and Prevention

Objectives

• Identify key characteristics of state laws allowing students to self-carry

• Review results of survey of practices, attitudes and beliefs

• Present recommendations for overcoming barriers to optimal access

• Discuss needs and opportunities in New England

The Problem

• Asthma is a serious chronic illness affecting nearly 7 million children

• It’s a leading cause of school absenteeism

• Asthma emergencies can be sudden and unpredictable

• Barriers to access to quick relief medication is potentially life-threatening

4

The Problem

Optimal Asthma Management in Schools

• All school systems should adopt and implement a comprehensive plan for the management of asthma that is based on current research and best practices.

• All school systems should adopt and implement an environmental assessment and management plan that addresses environmental asthma triggers.

www.lung.org/afsichampion

www.lung.org/asthmapolicyguide

www.lung.org/afsi

www.lung.org/openairways

Overview of State Inhaler Laws

• Under 2004 federal law, preference in funding was given to states that require schools to allow self-administration of asthma medications

• All 50 states and DC have subsequently passed such laws • Details of laws vary widely • Most state laws apply only to public schools

State Inhalers LawsMay Include :

• 1,526 respondents from 38 states– 16 states accounted for 94% of

respondents• 93% from public schools• 88% of respondents

were school nursesIL NC NY WA IA CA NH VA SC MN RI WI GA FL KY ND

0

50

100

150

200

250

300Respondents by State

Survey of Current Practices Among School Personnel

Some Limitations on AccessAre Asthma Medications Required To Be…

Kept In School Health Office

Kept In A Locked Cabinet

Administered In The Presence of A School Nurse/Other School Personnel

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

For all students with asthma Only for students not approved to self-carry No Uncertain/Not Sure

Requirements in order to self-carry/administer while at school:

Permission form from parent or guardian

Treatment or Action Plan On File From HCP

Demonstrate Correct Administration of Medication

Ability to Identify Signs & Symptoms of Asthma

Access to Backup Medication

Completion of Asthma Education Course

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Perceived Limitations

• One-third agreed or strongly agreed that lack of cooperation from parents was a limitation

• About one-fifth noted either record keeping/reporting or potential liability as limitations

Potential liabil-ity

Record keeping and reporting

Lack of parental cooperation

0%

5%

10%

15%

20%

25%

30%

35%

Defining “Optimal Access”

• Every child that is developmentally and physically capable of self-monitoring and administration of medication is allowed to do so

• Families, providers and school health staff are in communication about the student’s asthma and medication use

• Students are empowered to manage their own disease

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Barriers to Optimal Access

• Parent and healthcare provider permissions• Assessment of student readiness• Availability of back-up medication

Parent & Provider Permissions

• Cumbersome paperwork

• Lack of urgency

• Challenge of direct communication between school and providers

“We have a good system in place at our schools. The difficult part is having the parents obtain the Doctors order that verifies that they may

use their inhaler and self carry it.”

Assessment of student readiness

• Logistical hurdles

• Scarcity of qualified school personnel

• Attitudes and beliefs

“Some nurses do not want students to self-carry and self-

administer.”

Appropriate Age for Self-carry

• Few thought ok for youngest (K-2nd grade)

• Maturity was an important deciding factor for younger students, especially 3rd-5th grade

• Most thought ok by middle and high school

5-7 years, K-2nd

8-10 years, 3rd-5th

11-13 years, 6th-8th

14+ years, 9th-12th

0%

20%

40%

60%

80%

100%

60.6%

18.3%

1.6% 0.3%

34.8%

53.8%

20.9%

10.8%

4.5%

28.0%

77.5%88.8%

Not Allowed Depends on student's maturity or developmental level

Allowed

Availability of Back-up Asthma Medication

• Survey respondents believe back-up medication is critical, yet few laws and policies address it

• Challenge for families to provide second inhaler

“Students lose their inhalers on a regular basis and have no back-up

inhaler at school.”

Recommendations for Action

Awareness Engagement

Assessment Back-up

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Increase Awareness

• School personnel need to understand laws and policies• Families and healthcare providers need to understand students’

rights and responsibilities• Advocates need to understand how they can make a difference

19

Increase Engagement

• Schools must facilitate communication with families and providers• Simplify paperwork to increase compliance with requirements• Help families understand asthma control

20

Standardize Assessment Practices

• Ensure adequate school nurse presence• Reduce bias by using standardized assessment instruments• Build accountability and trust with student contracts and regular

check-ins

21

Ensure Access to Back-up Medication

• Implement standing orders for stock quick-relief medication• Develop model policies and case studies to acceleration adoption• Identify and advocate for workable payment structure

22

Next Steps for Inhalers in Schools Project

• Increase awareness of laws and policies among school personnel• Increase training and technical assistance resources for

stakeholder organizations and school personnel– Launch interactive awareness infographic– Develop model policies– Reconvene advisory group as reviewers– Promote and disseminate new resources

23

Next steps in New England?

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Questions

Discussion

Action

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