November 19, 1999

Study goes on-line to track asthma education

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Vanderbilt Children’s Hospital teacher Chris Gray (left) goes over a lesson with patient Randy Dixon. (photo by Dana Johnson)

Study goes on-line to track asthma education

Controlling a child's asthma takes more than having the latest technology at your fingertips.

There has to be the backup education effort to teach children and their families how to prevent and control asthma attacks. It's an educational effort at Vanderbilt University Medical Center that's reaching out to professionals and consumers alike.

Beginning this month, VUMC is joining an ambitious internet initiative studying the use of continuing medical education to change physician practice behavior in the treatment of pediatric asthma. The CME effort, funded by Merck U.S. Human Health, uses the 1997 pediatric asthma guidelines, issued by the National Heart, Lung and Blood Institute (NHLBI), in training physicians to treat patients with asthma, said Dr. Dennis C. Stokes, associate professor of Pediatrics and director of the Children's Hospital Asthma Center.

"Over the past decade, we've seen a pediatric asthma epidemic, particularly in inner city populations," Stokes said. "We currently do not have the knowledge to prevent asthma. What we do have is the knowledge to prevent the major impact of asthma on the millions of children who suffer from asthma. A major educational effort can have a great impact on frequent hospital admissions and emergency room visits, school absences, and other adverse consequences of poorly controlled asthma such as the inability to participate in school physical education and sports. For most pediatric asthma admissions, we do not recover our costs. So preventing unnecessary admissions can also save Vanderbilt money."

Stokes, who testified before Sen. Bill Frist's congressional committee on asthma this fall, said the key is educating physicians and patients. Vanderbilt recently hosted educational programs for primary care providers and allied health professionals, and a whole week for pediatric residents was dedicated to pediatric asthma care.

Dr. Gerald S. Gotterer, Senior Associate Dean for Faculty and Academic Administrative Affairs and Director of the Division of Continuing Medical Education, suggested internet-based CME and comparing the internet effort with traditional CME coursework in pediatric asthma. Vanderbilt partnered with the University of Alabama to develop the materials.

Vanderbilt is one of several centers across the country using Asynchronous Learning Networks (ALNs) for Continuing Medical Education use. ALNs combine using standard text material for self-study with moderated chat rooms with other professionals.

Physicians participating in the ALN method are given material on asthma guidelines, and then have the opportunity to interact with others taking the course and with pediatric asthma experts.

The Vanderbilt study is looking at the practice habits of about 300 primary care physicians in Tennessee and Alabama. The group is subdivided into three groups. One will be given a manuscript on pediatric asthma. Another will read the same material posted on the internet. The third group will receive the same material plus the chance to use the ALN. All three groups will receive CME credit.

Vanderbilt is partnering with Blue Cross/Blue Shield of Tennessee to see if the educational program makes a difference in asthma outcomes. The group plans to look at least six months of data after the physicians participate.

"It's a very ambitious project using a new way of learning," Stokes said. "Our hope is that we can change behavior. We know there is undertreatment of pediatric asthma. Physicians tend to use symptomatic treatments rather than preventive medicines that help prevent episodes of asthma."

Stokes said that physicians also need to learn how to educate families. Physicians should know how to use the devices that are used in treating patients with asthma and that has been the focus of recent provider courses.

Vanderbilt is also taking its effort into the community. A community educational program was recently held in Madison, an area targeted because of the number of admissions from that area.

Vanderbilt University School of Medicine has a Pediatric Asthma Education Elective for first and second year students. They learn about asthma basics, then are trained by a representative of the American Lung Association as instructors in Open Airways, a program for elementary school students with asthma. The students then spend six weeks teaching the curriculum to children with asthma in several Nashville schools.

Dana Adkins and Joanna Hwang work with a group of students at Tom Joy Elementary School each Friday for an hour.

"The program emphasizes two major points the children will remember," Adkins said. "They are not alone with their problem and they should be encouraged to participate in all activities in spite of their asthma."

Adkins said she has enjoyed participating in the elective.

"I receive the opportunity to work with children and to make a difference in their lives – something that is not too common for a first-year medical student."