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Primary Care Asthma Preceptorship Program (PCAP): A Novel Approach to Address Disparities In the Care of Children with Asthma and Promote Best Practices by Community-Based Providers

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Agnes Banquet, MD1, Sankaran Krishnan, MD1, Y. Cathy Kim, MD1, Amy Ansehl, RN, MSN, FNPC2, Heather Archer Smith, MPH2 and Allen J. Dozor, MD1, (1)Pediatrics, Maria Fareri Children's Hospital and New York Medical College, Valhalla, NY, (2)Institute of Public Health, New York Medical College, Valhalla, NY

Purpose: The purpose of this program is to address disparities in the medical care of children with asthma through improvements in the delivery of care within medical homes for asthma.  Physician or provider education using traditional formats such as didactic conferences or workshops for primary care providers have been shown to be insufficient, failing to adequately change professional practice or improve asthma outcomes, including rates of hospitalizations, emergency department utilization, or adherence to national clinical practice guidelines, particularly for black and hispanic children.  Studies suggest that to improve patient outcomes, continuing medical education (CME) must be reengineered to be more contextual, interactive, and personalized. We present a new model for CME developed from a partnership of academic pediatric pulmonologists, public health educators and community organizations including the faith-based community. PCAP was developed by the Children’s Environmental Health Center of the Hudson Valley, a collaboration of the physicians of the Maria Fareri Children’s Hospital and the faculty of the Institute of Public Health at New York Medical College.  The goals of this program are to improve the skills of primary care providers, particularly caregivers in safety net practices, in their ability to (1) accurately diagnose asthma in children; (2) manage asthma in children in accordance with NAEPP/NHLBI EPR-3 asthma guidelines; (3) integrate office spirometry into their primary care practice; (4) educate caregivers on the role of the environment in the management of asthma.

Methods: PCAP is a four hour individualized program during which participants work one-on-one with an asthma specialist directly in the care of their patients. Each participant receives a toolkit that includes a guide to the asthma clinical guidelines, a sample environmental history questionnaire for parents, a primer on office spirometry in primary care, and sample asthma action plans.  Each participant completes both a pre-test and post-test designed to assess change in knowledge base, as well as an evaluation of the program.

Results: In the first six months, 12 primary care providers, including pediatricians, nurse practitioners and physician assistants have completed the program, including practitioners in a variety of healthcare settings that serve a diverse population of children. Emphasis has been on attracting practitioners from federally funded neighborhood health centers. The program resulted in significant improvement in participants’ knowledge.  Median (IQR) pretest score was 0.56 (0.38-0.65), and median (IQR) posttest score was 0.86 (0.79-1.0), p < 0.02. All participants rated the experience as excellent and agreed that this would change their practice.

Conclusions: A new CME model designed to decrease disparities in asthma care for children and promote best practices by primary care providers in diverse communities appears promising.  Studies are needed to determine whether in addition to increasing knowledge of providers, this individualized learning model can affect patient outcomes.