Asthma Home-Based Services
The Minnesota Department of Health (MDH) Asthma Program encourages local public health (LPH) and other health-based agencies to incorporate asthma home-based services into their routine home visiting programs.
Home-based services are a unique opportunity for a health care professional to visit the asthma patient in their own home environment. Meeting with families at their home creates the opportunity to provide individualized patient education, review asthma action plans, and answer patient’s questions in an environment they are comfortable in.
It is important that asthma patients understand what triggers may cause their asthma to flare up and learn ways to reduce exposure or eliminate triggers as much as possible. What may trigger a person’s asthma is very specific to that individual. Some of the more challenging asthma triggers are inside the home. These include tobacco smoke, dust mites, mold, saliva and dander from furry and feathered pets and pests such as cockroaches and mice.
Home-based services afford more time with the patient and allow the health care professional an opportunity to assess the home for potential asthma triggers. Health care professionals can use the results of the environmental home assessment to understand trigger exposure and better tailor a plan to support daily patient self-management.
How home-based services impact health
Projects conducted by MDH have repeatedly demonstrated the effectiveness of home-based services that include both asthma self-management education and home environmental assessments for people with asthma. Our model has demonstrated:
- A positive return on investment (ROI) – the ROI ranged from $5.25 to $1.61 for every dollar spent.
- Improved asthma control;
- Fewer asthma symptoms;
- Reduced missed days from school and work;
- Reduced use of unscheduled clinic, emergency department, and urgent care visits and inpatient hospitalizations.
In our most recent project, the number of missed school days was reduced by an average of 2.42 days in the previous 3-month period. This is equivalent to increasing school attendance by 7 days over a 9-month school year. The number of work days missed was reduced by 0.48 days over 3 months.
How home asthma services happen
A referral, potentially coming from the patient’s prescribing health care provider, is the first step in getting an asthma home visit scheduled for a client/patient with poorly controlled asthma.
Health care systems, clinics, and providers struggle with sufficient time to provide asthma education in the clinic setting and they don’t have the opportunity to see what triggers may be affecting their patients asthma in the patient home. Home visits can provide asthma care that meets the medical and educational needs of the individual patient. Medical treatment including daily medications in addition to effective management of asthma environmental triggers in the home can reduce the number and severity of an individual’s asthma episodes.
Home services are provided by a trained:
- Public Health Nurse
- Certified Asthma Educator (AE-C)
- Respiratory Therapist
- Community Paramedic
- Community Pharmacist
Some programs may utilize a Community Health Worker to follow-up with the initial recommendations, which support, and reinforce patient understanding and learning.
Past Demonstration Projects, provide good examples to understand home visits, how they happen and what the impact could look like.
MDH also offers an Asthma Home-Based Services Toolkit for LPH and other non-profit organizations that are interested in developing a program to deliver asthma home-based services.
MDH asthma home-based services model
This model presents just one way of delivering asthma home-based services. Many other models can be adapted to different settings including public health organizations, community health centers, clinics, hospitals and schools. This model’s approach is consistent with the National Guidelines for Diagnosis and Management of Asthma (EPR-3).
Component 1: Assess Home Triggers
- Assessment of the home environment – a walkthrough (visual assessment) that includes the person with asthma or a family member (the focus is on the sleeping area).
- Review the results of the home assessment with the individual and family – asthma triggers will be identified and action steps recommended to reduce or eliminate asthma triggers found in the home.
- Additional visits by a Public Health Nurse or Certified Asthma Educator will be scheduled to reinforce the education that was included in the initial visit.
- Refer out or provide additional community resources as needed to support the social needs of the family and patient.
- Access local environmental health and healthy homes staff with expertise in housing to support more complex building and asthma trigger issues.
Component 2: Assess Asthma Control and Provide Asthma Self-Management Education (ASME)
- Managing asthma successfully means regularly assessing how well controlled a patient’s asthma is, monitoring symptoms and risk factors, and the risk for developing symptoms, and taking medications according to an individualized asthma action plan (AAP).
- Providing individualized asthma self-management education is included during an initial home visit and with subsequent follow-up visits. The goal is to assess and increase the patient’s ability to understand and follow their personalized written AAP and to take action according to the plan.
- An AAP provides a list and guidance on what asthma medications the patient takes and when, what symptoms to watch for that indicate asthma is not being well controlled, and when to seek emergency medical care.
- The asthma educator also provides an overview of how asthma affects a person’s ability to breathe and gives them guidance on how to manage their asthma every day.
Minnesota programs offering asthma home-based services
The following Minnesota programs currently offer in-home services for asthma. Please see contact information to inquire about services provided and current eligibility.
Offers asthma home visits for children living in Minneapolis and Greater Hennepin County who have poorly controlled asthma or are newly diagnosed. A public health nurse specializing in pediatric asthma will:
- Educate regarding asthma diagnosis and what it means for the child and the child’s family.
- Provide asthma self-management education; understanding the different roles of medication and devices.
- Conduct home environmental assessment for asthma triggers.
- Reinforce and educate regarding the child's Asthma Action Plan.
- Coordinate remediation if necessary. Coordinate clinic and provider appointments to ensure continuity of care.
The Healthy Homes program sends an Environmental Health Inspector and a Public Health Nurse to assess homes for asthma triggers and to provide asthma self-management education. This program teaches families how to reduce environmental triggers of asthma and to create a healthier home environment for their children. Families may be eligible to receive free products from Ramsey County to help manage their children’s asthma. Some of these products may include a HEPA air cleaner, high efficiency vacuum, bed and pillow encasements, cleaning supplies, radon monitor, and pest control supplies.
A home assessment includes:
- An opportunity to discuss any issues that children are experiencing with asthma or allergies.
- Lead, mold/moisture, and pest checks
- Radon testing.
Contact Matthew Kudwa at 651-266-1139 or firstname.lastname@example.org to schedule a healthy homes visit.
St. Louis County offers free asthma home visits for children and adults, living in St. Louis County, who have poorly controlled asthma. A St. Louis County Public Health Nurse can:
- Conduct a home assessment for asthma triggers
- Provide asthma self-management education
- Offer care coordination and support
- Provide one-on-one instruction on how to use asthma medications and the importance of following an individualized asthma action plan.
- Tools and equipment may be available to help reduce asthma triggers in the home.
Contact Lisa Konicek, Registered Nurse and Public Health Nurse at 218-726-2289 or KonicekL@stlouiscountymn.gov