Question of the Month in Cross-cultural Health Care

The most important thing to remember in cross-cultural health care is “NEVER ASSUME…ALWAYS ASK.”  It is not what you know, it is what you ask.  You don’t need to know about all of the cultures.  You just need to ask the right questions to understand how the family you are talking with is influenced by their unique values, beliefs, concern, needs.  Each month we will suggest a question for you to try out as part of your routine visits.  Adapt it to where you are comfortable.  See how it works for you. 
This month’s question is:

“Please tell me a little about where your family comes from originally.”

1. Proper use of coordination of care codes
2. Identification of children in the practice with special health care needs
3. Care continuity
4. Continuity across settings
5. Cooperative management between primary care provider and specialist
6. Supporting the transition to adult health care services
7. Family support
8. Needed forms
9. How to negotiate with public and private insurers
10. Job descriptions and roles of staff
11. Documentation
12.  Resources for children with specific conditions

• Portable Document Format (.pdf)
• Microsoft Word Document (.doc)

IMPACT *

We invite your participation in an exciting new program called
* Improving Pediatric Asthma Care Training.

We guarantee IMPACT will impact and improve pediatric asthma care in your office.

The IMPACT program will offer:

• Resources specific for your practice to diagnose and manage children with asthma
• Fun, innovative and effective CME video case simulation sessions with pediatric asthma and educational experts for your office to acquire the most up-to-date information on pediatric asthma (including the new National Asthma Guidelines)
• On-going support for pediatric asthma management to include follow-up educational sessions, direct access to pediatric lung specialists at Children’s Hospital and access to on-line library resources
• Opportunities for 1-2 day on-site training at the Children’s Hospital by the Asthma team (Mini-Asthma residency) to immerse you and your staff in pediatric asthma care
• Deeper understanding of and access to tools specific for your office system to improve asthma care
• Access to other Children’s Hospital programs to include hospital treatment pathways in pediatric asthma and tobacco cessation

We will be conducting initial “focus groups” to understand current practice, barriers to asthma care and optimal approaches to CME and follow-up education. Please contact Gloria Nussbaum, RN, MSN at 303-724-0335 to set up a luncheon in your office for this brief session. Thank You!
 

Parental Smoking and Childhood Asthma: What You Can Do To Clear The Air

Major Conclusions from the US Surgeon General’s 2006 Report: “The Health Consequence of Involuntary Exposure to Tobacco Smoke”:

• “Secondhand smoke (SHS) causes premature death and disease in children and adults who do not smoke.”
  
• “There is no risk-free level of exposure to SHS.”
  
• “Children exposed to SHS are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma.  Smoking by parents causes respiratory symptoms and slows lung growth in their children.” 

Other Key Points from this Report:

• SHS exposure is greater in persons with lower incomes.  So, minority families are more at risk than the general population to the extent they are poor.
  
• The home is now the major source of SHS exposure for children.  Workplace and public smoking bans have lead to reduced SHS exposures, but these reductions are much greater in adults than children.  Biomarker studies suggest that children now have, on average, double the exposure of adults.
  
• Maternal smoking during pregnancy causes persistent adverse effects on lung function across childhood.
  
• Postnatal exposures to SHS cause increased respiratory symptoms (e.g., cough, wheeze, breathlessness), increased incidence of wheezing illnesses, increased chance of ever having asthma, and lower level of lung function during childhood.  Evidence is suggestive that most of these adverse effects persist into adult years, even among children who themselves never smoke.
  
• Childhood SHS exposure appears to increase the risks of cancer during childhood and later in life.

Other Relevant Points:

• Once a child has developed asthma, more than 20% of all child asthma attacks are triggered by tobacco smoke in the children’s homes.  
  
• Despite this causal connection between parental smoking and asthma exacerbation, children with asthma are as likely to live in a home with smokers as healthy children.
  
• Although some “harm reduction” strategies (e.g., always smoking outside) can reduce the risk of parental smoking to children, even the best of these strategies does not remove all smoke (and hence risk to children) from the home.  As such, helping parents quit smoking is the best way to improve the health of their children.
  
• There are brief and effective steps you can take in your practice to reduce asthma incidence, morbidity and mortality.

Are you doing all you can to clear the air around your patients and safeguard their health?

You can make a huge difference.  Brief (≤ 3 minute), routine, and systematic inquiry and counseling about personal smoking and SHS exposure by health care professionals are clinically effective and extremely cost-efficient interventions.  For example, following the “5A’s” (Ask, Advise, Assess, Assist, Arrange) with tobacco smokers triples cessation rates.  These procedures work best when they are built into the flow of your clinic operations (e.g., personal smoking and SHS exposure recorded every visit as a “vital sign;” the required resources to advise, motivate, and assist patients to change are easy for clinicians to access).
 
Our question to you is, “Are you doing all you can to clear the air around your patients and maximize their chances of optimal health as a child and on into their adult years?”  If you think you are, are you willing to have us visit your practice and learn from your success?  If you think you are not, may we provide a free consultation to you about ways you might implement brief, evidence-based tobacco control strategies in your practice?

With support through our local EPA office, a team comprised of practice change specialists from National Jewish, TCH and UDCHSC, will come to your clinic at a time convenient to you and conduct a brief (2-4 day) card study of your current tobacco control practices, getting information from clinicians and patients.  We then will share the results of this card study with you, and based on your thoughts and wishes, discuss options that you might want to consider to improve what you are doing.  For more information about this project, please feel free to contact Fred Wamboldt, MD, at 303-398-1827 or wamboldtf@njc.org.

Help from CIIS in Reminding Families that their Child Needs Immunizations

Recall of patients who have missed immunizations is a “best practice” to improve immunization rates.  CIIS automatically identifies children in a designated age range who are not current on recommended immunizations and generates an electronic file that is used to create labels for recall notices.  CIIS immunization coordinators are available to train and assist your office staff in using this CIIS function. CIIS can also help design and create mailings for your practice to send out.

If your office needs additional information about participating in CIIS or about using CIIS recall please contact Kellyn Pearson at 303-724-1075, kellyn.pearson@uchsc.edu.  An immunization coordinator will contact you to work with your office to implement CIIS and recall.