By Dr. Ehrlich
I noted with great interest our Journal item* on an 8-week school-based program at New York City high schools, which helped reduce emergency treatment for asthma patients by huge percentages. In most other areas of medicine, reducing ER visits by half and cutting hospitalizations by three-quarters might seem revolutionary. But in asthma control, it’s standard operating procedure. The trick is in getting patients and supporting institutions to go along. My colleague at NYU Langone Medical Center, Jean-Marie Bruzzese, PhD, assistant professor of child and adolescent psychiatry, along with her co-authors Robert B. Mellins, MD and David Evans, MD, of Columbia University College of Physicians and Surgeons deserve all the credit in the world for making it happen. They had to work with the New York City Department of Education, which is a challenge in and of itself.
I know all about working with the New York DOE because of my own program called Project ERASE, which takes me regularly to elementary schools. We also have achieved these eye-popping percentage improvements. My work involves one-to-one interactions with smaller children, their parents, their teachers and schools themselves.
While our programs are very different in approach, they have two key elements in common. One is that they use the school as the forum for treatment and education, instead of requiring a special trip to another clinic. School is a place the kids have to be. The children feel “at home” and less threatened than they might in the doctor’s office. Working parents do their best to make sure that their children attend because the school day is what allows them to make a living.
The other key is that the children spend a lot of time on a regular basis learning about their disease and making the behavioral changes in their lives that are instrumental improving their health. For little kids like the ones I deal with, attention from a specialist who follows up with their family doctor (even if that means calling an emergency department where the child has been seen), parents, and school officials helps reinforce the message. At the high schools, kids spend enough time—8 weeks—to learn what to do and change their habits.
Is one approach superior to the other? Who cares? I don’t. What I see are results. Unfortunately, because of scarce funding, other doctors who went to the schools for Project ERASE can no longer be paid the small hourly stipend they were getting, so I am doing this at my own cost. As a matter of public health, not spending the money is pennywise and pound foolish, considering that each hospitalization prevented saved the health care system as a whole much more than the cost of that doctor’s time for the year.
One of these days, the people who pay for health care in this country are going to wise up. They will see that a bit more money for prevention and control pay off like slot machines—only the odds are not with the house. They are with patients, schools, and even payers. Fewer emergencies, lower costs, better grades, better lives.