374 - School-Based Asthma Management for Historically Marginalized Youth: Appreciation for the School Nurse Perspective

Asthma remains prevalent and associated with substantial morbidity, especially for historically marginalized youth. We have found that preventive asthma care facilitated by school nurses can improve student outcomes. Understanding the views of school nurses about this approach is essential in considering sustainability.

Objective: To assess school health staff perspectives of school-based asthma management programs implemented in Rochester NY.

Design/Methods: School nurses and aides involved in school-based asthma management programs were offered anonymous surveys at the end of the study periods in 2016 (SB-TEAM), 2019 (SB-ACT), and 2021 (TEAM-UP/TUFT). These trials enrolled youth, in cohorts aged 4-12yrs or 12-16yrs, with physician-diagnosed asthma or poor control and tested directly-observed therapy (DOT) of preventive asthma medications at school. Two of the programs also included school-based telemedicine asthma assessments with clinicians to facilitate guideline-based prescriptions for DOT. Data from overlapping nurse survey questions were combined for descriptive quantitative and qualitative analyses.

Results:

We received 50 responses from RNs (54%), LPNs (16%), heath aides (26%), and others (4%) who did not provide their role in the Rochester, NY city and area school system. Ninety-two percent of respondents worked full-time and 38% were assigned to >1 school. Overall, respondents agreed or strongly agreed that our school-based programs would be feasible to continue in their school (94%); should become a standard of care (98%); were compatible with school district health practices (84%); and provided benefits to students that outweighed burdens to the school health staff (84%), which averaged 36.7 minutes/week per participant. Most agreed/strongly agreed that students who participated were healthier (73%) and missed less school (74%). Contact with the study team was "just right" for most (97%), and some indicated communication with parents (57%) or providers (37%) was improved by program participation. Qualitative themes highlighted positives (more nurse engagement with students to monitor and teach, more support for parents, better medication adherence and outcomes for students) and concerns (barriers related to medication insurance coverage, screening for enrollment, reaching students when not in school). 

Conclusion(s): School-based asthma management programs and policies that facilitate collaboration between nurses, providers, students with asthma and their caregivers may be key to improve health. School health staff input suggests these approaches may be feasible, acceptable, and beneficial.