After a week of data-driven and patient engagement conferences in Washington, DC, we traveled to Louisville to conduct interviews with different stakeholders. Through these discussions, we identified challenges related to childhood asthma, including a lack of health literacy and understanding about asthma as a chronic illness that requires constant management, even when one feels normal and asymptomatic. Providers stressed that in order to properly manage asthma, patients and parents should embrace preventative care, such as regularly using a controller inhaler, as opposed to only using a reliever inhaler in the event of an attack or when experiencing difficulty breathing. Additionally, school children face challenges, including staff being fearful of allowing children to engage in physical without their inhaler and parents not wanting to label their child as “asthmatic” due to risk of increased insurance costs. Focusing solely on “education” is not enough; an active and engaged partnership between the provider and patient is vital. Frequently, providers give patients educational resources about their conditions, but with low rates of adherence and high rates of emergency room visits, health care professionals emphasize that more needs to be done.
For example, physicians often ask their patients “Do you have any questions?” at the end of their visit. Sometimes patients are extremely overwhelmed or feel as if they are rushed and do not take advantage of this opportunity. It is important for providers and patients to work together to create a relationship and dialogue that is open, honest, and comfortable. For example, a spacer is an important component of asthma management yet, a nurse practitioner with 15 years of experience working in the Jefferson County Public Schools had only seen about five students use spacers while using their inhaler. This is critical because without the spacer, a child with asthma only receives about 40 percent of the medication into their lungs. Problems such as these could be solved with interactive partnerships between physicians and patients.
A promising concept we learnt about is “gamefication,” which can turn current disease management into an interactive and fun experience that appeals to children. However, one striking problem that a pharmacist brought up is that many in the underserved population do not have access to a smartphone. This makes reliance on a gamefication strategy challenging if many of our target audience are not able to access these technologies. Our key takeaways from our candid conversations with providers, start-up companies, and insurance entities are that an increase in medication adherence is imperative, there needs to be increased understanding and ownership of asthma by parents and patients, and it is essential to have honest and open communication between the patients and providers. As we continue on our journey in San Francisco later this week, we are excited to be exposed to design thinking and incorporate what we have learned thus far to the creation of a unique approach to combat childhood asthma.