by Melissa J. Smith and Natalie GutierrezThe Health Science Centerís South Texas Asthma Management Program (STAMP), the first and largest of its kind in the United States, seeks to evaluate the benefits of various levels of intervention for asthma patients and to determine which method best prevents asthma attacks. The goal of the study is to provide objective data about asthma disease management to federal government leaders who will make decisions regarding funding for asthma care programs.
More than 920 children and adults are enrolled in the study, which targets the underserved, minority population. The study is funded by a $2.5 million, four-year competitive grant from the U.S. Department of Health and Human Servicesí Office of Minority Health. Congressman Henry Bonilla is a leader in securing funding for the study each year. Gregory Freeman, M.D., and Jay Peters, M.D., professors in the department of medicine, and Stephen Inscore, M.D., associate professor in the department of pediatrics, are the principal investigators. Study participants are underinsured or have no insurance, range in age from 5 to 64 and live from the south edge of Bexar County up to Pflugerville.
The study seeks to answer three questions: 1.) What type of clinical care is better for patients? 2.) Which is the most cost-efficient type of care? and 3.) Which produces the best quality of life for the patient? Study participants have been divided into three groups.
Standard Care Group
Standard care is the type of care most asthma patients in the United States receive. Patients visit their physicians usually three to six times per year to discuss their symptoms and receive medications and instructions. Common drawbacks of this method include patients taking medications ineffectively or not understanding physiciansí instructions with few opportunities for clarification.
Disease Management Group
In addition to the standard care, patients receive monthly telephone calls from registered nurses who answer their questions, review medication instructions and provide general information on asthma and asthma triggers. Additionally, the nurses mail asthma-related information to the patient or patientís family and, in the case of a child, also to the childís school nurse. If the nurse observes that the current medications arenít effective or that the family is having difficulty affording the medication, the nurse calls the primary care physician to make recommendations. Common drawbacks of this method can include a language barrier, misunderstandings involving over-the-phone instructions or an inability of the patient to read information mailed to him or her.
Home Care Group
Patients receive the care of the disease management group and are visited four times over the length of the study by a respiratory therapist (RT) in their homes. The RT evaluates the home environment and makes recommendations to the patient and his or her family on how to eliminate and control asthma triggersin the home. Triggers can include pet dander, cockroach sheddings, and dust mites in carpeting, curtains and toys. The RT also observes the patient using his or her medications and peak flow meter. A peak flow meter is an instrument that measures how well a patientís lungs are functioning.
In addition to being a citywide collaborative effort that includes Wilford Hall Medical Center, Brooke Army Medical Center, CHRISTUS Santa Rosa Health Care, University Health System and the South Texas Veterans Health Care System, the study combines the expertise of Health Science Center faculty from the Medical School, the School of Nursing and the School of Allied Health Sciences. The study also includes the collaboration of the Community Care Services Department clinics in Austin.
"There arenít many studies that bring together a coalition quite this broad," said Autumn Dawn Galbreath, M.D., M.B.A., assistant professor of medicine and project director for the study. "There is a great potential for this study to help define the future of asthma care."
The study is no longer enrolling study participants and will be completed in August 2006.
As prevalence of asthma increases across all age groups, sexes and racial groups, effective and cost-efficient means of asthma care must evolve to meet the demands of this growing population. In the United States, where more than 20 million Americans suffer from asthma, Health Science Center researchers are leading efforts to improve the future for asthmatics.
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