Program's Web site: http://galantandlin.com/asthma/services/index.htm

Answers provided by Dr. Stanley Galant, Medical Director

1) What is the name of the asthma mobile program in your city?

The Orange County Breathmobile.

2) When was it established?

We first started doing this in April 2002. It became an official program in October 2003.

3) How and why was it established?

I did it myself, initially. I borrowed a van from the Children's Hospital of Orange County and went out to schools with a nurse and a driver. Eventually, working through the Allergy and Asthma Foundation of America, we received a California endowment grant and were able to get our own van. With the grant, I was able to bring aboard a fulltime allergist and a nurse, and we hired a driver as well.

I was familiar with a program at the Los Angeles Children's Hospital and University of Southern California, and I thought it was something that I would really like to do with my life. I thought it was a wonderful approach to help inner city kids, which is a population that is underserved and undertreated. I did a needs assessment, and established that there was a big need in Orange County. We found that 10 percent of all the kids in elementary school, regardless of ethnic background, had significant rates of asthma.

4) Who is served by the program?

They are mainly Hispanic inner city kids. These are kids in Orange County who go to schools where 80 to 85 percent are either on reduced or free lunch programs—underserved, impoverished children. Most of the kids are in pre-school or elementary school; we serve a few kids in the middle school and high school.

5) How does the mobile program work in your city -- where does it go and when, and how does your team publicize the routes?

We give a schedule to the school each month, so they know exactly when we are going to be there. Basically, the children we see are identified by school personnel. The children are referred to us. We schedule them, and they're seen as soon as possible. We see 10 to 15 patients a day and go to the school about four-and-a-half days a week. We arrive at about 8:30 a.m. and stay until 2:30 p.m. We perform physical examinations, skin testing; the doctor then makes a determination as to diagnosis and severity. Then, a management program goes in place that is heavily weighted in terms of education. We also do home visits for high-risk kids. We give out free medication to those who have no insurance; those who do have insurance, we give them prescriptions. We try to enroll every child into low-cost insurance. One of our goals is to enroll these kids into a primary care environment.

When we finish the evaluation, we give a summary to the school and we send a summary to the primary care doctor. The child is usually invited back one month later, and then the visits are spread out according to the success of the treatment. We also have a fulltime pharmacist on the van whose main role is to assess and improve compliance with medication care.

6) How do parents and kids find out about the services offered?

The schools are a big ally. They find out mainly from school personnel, word-of-mouth from other parents, health fairs.

7) How are the services funded?

A California endowment grant was originally provided for year one. The tough part is sustainability. We are also dependent on other sources of granting. Hospitals, like Keiser, Children's Hospital of Orange County; we also bill the insurance of the patients. We have donors as well. We are always looking for funding.

Our goal would be to have the county, state and feds support us. The national agenda is to help the underserved, and that's what we're doing.

8) What gaps does this program fill in your city?

First of all, I think asthma care for children is not very good: it's dependent on a couple of assumptions, which may not be realistic. First of all, the child has to be diagnosed, and the diagnosis of asthma is time-consuming and tricky. It also takes a lot of education and time to treat. In a typical primary care practice, it's very difficult to do.

In this population, it's one step removed. The gap is that these people don't usually get any kind of care. We're providing specialty care, which would be unheard of for this population. We're really, I think, making a big difference in the community.

9) How many kids are served by your program?

We've enrolled over 800 children.

10) Over the last 10 years, how has the asthma rate changed for children in your area?

Certainly, I think that there is a large prevalence. We think it has doubled within the last few decades.

11) How is your program affecting the kids you serve?

We are looking at several different outcomes: symptom control, morbidity and economics. In terms of symptoms, if the patient has attended 3 visits, we can demonstrate that their asthma is essentially controlled. In terms of morbidity, we can significantly reduce the number of missed days of school. Hospitalizations and emergency department visits are also almost totally eliminated. In terms of economics, the program costs about $450 thousand a year—it comes down to about $800 to $900 a year per child. If you look at the morbidity that these kids have, we think it's at least cost-neutral, if not cost-saving. We're also starting to track quality of life.

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