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EPN 2018

Robert J Goldberg

Robert J Goldberg, Speaker at Pediatrics Conferences
University of Massachusetts Medical School, United States
Title : Barriers and facilitators to the real-world implementation of supervised asthma therapy in public schools: A qualitative study of school nurse perspective


The attitudes of school-based nurses to an asthma management program for school-aged children and adolescents. Background: Randomized controlled trials have demonstrated that school-supervised delivery of inhaled corticosteroid therapy reduces asthma-related morbidity in school-aged children. However, successful evidenced-based interventions have not been incorporated into routine school practice. Objectives: Asthma Link is a clinical program that provides school nurse-supervised inhaled corticosteroid therapy to high-risk children with asthma. This intervention is a real-world application of evidenced-based interventions of supervised asthma therapy. We examined the perspectives of school nurses involved in Asthma Link to determine barriers and facilitators to real-world program implementation in public schools in central Massachusetts. Methods: Asthma Link included 38 schools and 108 school-aged children in central Massachusetts. Semi-structured interviews were conducted with school nurse participants in Asthma Link (n=16) based on five constructs: Process, Barriers, Facilitators, Satisfaction, and Problem Solving. Interviews were recorded, transcribed, and open-coded. Thematic analysis was used to identify major themes discussed in these interviews. Results: School nurses identified the following facilitators to successful implementation of Asthma Link: (1) willingness to participate in the program (no school nurses refused to implement the program); (2) appreciation of the opportunity to connect with the pediatric asthma provider, be a central member of the healthcare team, and supervise preventive medication delivery; and (3) self-identification as professionals to engage families and children in understanding the importance of preventive asthma care and daily medication adherence. Barriers to the implementation of this program were: 1) difficulty communicating with families and health care providers; 2) frustration with families not bringing the prescribed asthma medication into school; and 3) concern that some school nurses may not think it is their responsibility to administer daily preventive asthma medication. School nurses suggested that medical offices have a liaison tasked with working with school nurses and that an electronic system be developed to ease communication between parties. Overall, the surveyed school nurses found Asthma Link to be an acceptable program to incorporate into their everyday practice given the brief time needed, the ease in making it part of their morning medication distribution routine, and that this program creates a positive impact on children with asthma, including reduced asthma symptoms and rescue inhaler use and fewer school absences. They also agreed that Asthma Link helped children develop a medication routine, thus improving treatment adherence. Conclusions: Despite evidence supporting supervised asthma therapy in schools, this modality is not widely adopted into routine practice. School nurses identified several key issues that can be addressed in intervention protocols to successfully implement the evidenced-based Asthma Link intervention in routine practice and have an important public health impact on pediatric asthma.


Dr. Robert J. Goldberg, Ph.D., is Professor and Chief, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, in the Department of Quantitative Health Sciences at the University of Massachusetts Medical School. He is also Program Director of the medical school’s Masters of Science in Clinical Investigation (MSCI) Program. Dr. Goldberg has been actively involved in community-based studies of the natural history and primary and secondary prevention of coronary heart disease, heart failure, and deep venous thrombosis for more than three decades. He and several clinical researchers established the Worcester Heart Attack Study in the early 1980s. Through the current period of federal funding support, they are examining more than three-decade-long trends (1975-2007) in the incidence rates, in-hospital and long-term survival, and therapeutic approaches used in the management of more than 14,000 greater Worcester, Mass. residents hospitalized with acute myocardial infarction at all medical centers in the Worcester metropolitan area. He also presently serves as the Co-PI on a population-based surveillance project that is examining changing trends in the incidence, hospital and long-term case-fatality rates, and management practices of in and outpatients with venous thromboembolism among residents of the Worcester metropolitan area. He is also receiving funding support from the National Heart, Lung, and Blood Institute to develop community-wide hospital and outpatient surveillance for heart failure in greater Worcester residents. Dr. Goldberg serves as the senior epidemiologist for the Global Registry of Acute Coronary Events (GRACE) Project, which is a large multinational coronary disease registry examining differences in the management practices, hospital, and post-discharge outcomes of more than 50,000 patients hospitalized in 14 countries with an acute coronary syndrome.