When asthma attacks led to the deaths of three San Antonio children in 2017, the local medical community activated to increase efforts to combat the chronic yet treatable disease.
In February 2018, the South Texas Asthma Coalition (STAC) re-emerged after eight years dormancy in response to the toll that asthma has taken on local residents, requesting a $900,000, two-year grant from the City of San Antonio to fund a community-based asthma treatment and prevention program. It targets children with asthma at high risk of serious and uncontrolled symptoms, intervening through educational initiatives before symptoms worsen.
City Council approved $751,338 for the program over the next two years Thursday as part of the fiscal year 2019 budget.
The pilot program, known as Pediatric Managing Asthma Through Care Management in Homes or PMATCH, will be managed by a volunteer team of 80 doctors, public health specialists, school health officials, and insurance and hospital representatives. It will connect asthma sufferers with a promotora – a community health worker – trained to assess asthma symptoms and educate patients about proper medication usage and how to reduce environmental triggers in the home such as mold, pet dander, bug and rodent infestations, indoor smoking, and more.
“There is absolutely no question that asthma is a controllable disease in 99.9 percent of patients. Unfortunately only about 50 percent of asthmatics in Bexar County are adequately controlled,” said Dr. Joe Diaz, STAC member and local allergist.
Asthma symptoms can be debilitating, negatively impacting school attendance and workplace productivity, and contribute to “abuse and inappropriate overuse of emergency room visits, and can ultimately lead to death,” Diaz said.
While referrals to the program may come from all over the city, the rate of asthma-related emergency room visits and hospitalizations are significantly higher in certain areas of the city, Diaz said. The highest number occur in the 78207 zip code, one of the city's poorest.
The PMATCH program also will target residents in the 78228, 78227, and 78218 zip codes.
The asthma coalition tracked data on asthma-related emergency room visits from University Hospital System, Children’s Hospital of San Antonio, St. Luke's Baptist Hospital, and Methodist Hospital to determine which areas had high admission rates, said chair Dr. Mandie Svatek, a pediatrician and associate professor at UT Health San Antonio.
For that reason, the PMATCH program will operate out of the Frank Garrett Community Center, located in 78207 on the city’s West Side. Councilman Roberto Treviño (D1) told the Rivard Report that the program is a “worthy investment” for the West End Park area where the community center is located.
“Quite frankly, in hearing that there are children in those neighborhoods that are dying due to [severe asthma symptoms], issues related to air quality, and environmental situations in the home, investing to help treat asthma and prevent deaths is probably one of the most important things that we can do,” Treviño said.
Asthma is a lung disease causing inflammation and narrowing of the airway which makes it harder to breathe, especially when a person is exposed to environmental triggers such as infections, weather conditions, smoke, chemicals, pet dander, or dust, said coalition member Dr. Erika Gonzalez-Reyes. But if treated correctly, people with asthma should be able to do anything that someone without asthma can do, she said.
Gonzalez-Reyes, an asthma and allergen specialist who has practiced in San Antonio since 2006, said that in-home visits from promotoras will help “get down to the root of the problem” for an asthma sufferer, which often includes improper medication usage, inability to afford medication, and limited or no access to medical care.
“Home intervention programs have proven to be successful, so we know if we go into the home we can better assess and address social disparities, and connect them to the right community resources that exist that they might not be aware of, which will lead to improved outcomes and a decrease in hospitalizations,” Gonzalez-Reyes said, noting that local hospitalization rates are well above those in either Houston or Dallas.
“This is about investing resources in an area where it needs it the most, and understanding how important it is to take a needs-based approach,” Treviño said. “I am thrilled [the program] is part of our budget. It will really be transformational for that community.”
Svatek said that the money approved for the PMATCH program will provide funding for promotoras for two years.
“The goal is to prove that we can benefit our children, lower treatment costs, and help the community,” Svatek said. “Then we can pass this information to managed-care organizations, and they can build this into a sustainable model where it's paid for as preventative management or preventative care.
"If we are saving them emergency room visits we are saving managed care in the long-run.”