School-based asthma therapy: Improving medication adherence, asthma control, and health care utilization

Background: Undertreatment and poor adherence remain prevalent for children with persistent asthma. School-based asthma therapy (SBAT) provides guideline-based treatment by systematic school-based asthma screenings and direct administration of daily controller medications. Objective: We examined asthma control and health care utilization for children enrolled in the SBAT program in Columbus, Ohio, from 2013 to 2019. Methods: Six-year retrospective medical records were reviewed for 1 year before and 1 year after SBAT enrollment for children aged 5 to 19 years from 2 metropolitan school districts. Asthma control was assessed by the Asthma Control Test (ACT) and health care provider (HCP) ratings. Information was collected regarding asthma-related health care utilization, including emergency department (ED), urgent care, and acute care visits; hospitalizations; and pediatric intensive care unit (PICU) admissions. Results: Percentage increases in well-controlled asthma were 37% (ACT) and 56% (HCP). Asthma-related ED visits decreased by 49%, hospitalizations 50%, PICU admissions 71%, urgent care visits 41%, and acute care visits 38%. Black and Latino children had significant improvements. Black children saw 40% (ACT) and 66% (HCP) increases in well-controlled asthma, with reductions of 42% in ED and urgent care visits, 52% in acute care visits, and 49% and 67% declines in hospitalizations and PICU admissions, respectively. Latino children had 55% (ACT) and 33% (HCP) asthma control improvements, with 62%, 81%, and 50% drops in ED, urgent care, and acute care visits, respectively; hospitalizations decreased by 40% and PICU admissions by 100%. Conclusions: The SBAT program would serve well as a model for enhancing controller medication adherence, reducing morbidity, and bridging the health disparities gap for children with poorly controlled asthma.