Individuals involved | Inner/outer setting | Process | Intervention adaptation |
---|---|---|---|
Step 1 (deliverer/recipient of interventions who identified barrier) | Step 2 (systems-level partners selected by expert consensus group to address barrier) | Step 3 (elicited solution to barrier) | Step 4 (adaptation to intervention components based on expert consensus group and multi-level input) |
a. Barrier: Providers did not have time to determine if the patient was eligible, thus did not introduce program to eligible families | |||
Medical providers | Practice managers | Practice managers offered to systematically identify and flag eligible patients for providers | Practice trainings now ask practice managers to systematically identify and flag eligible patients for providers |
b. Barrier: Family unable to pick up 2 inhalers from the pharmacy | |||
Families School nurses Medical providers | Pharmacists | Pharmacists recommend the provider’s prescription should specify to dispense two inhalers. | Practice training teaches providers to specify on the prescription to “dispense 2 inhalers, one for home and one for school” |
Health insurers | Recommend establishing a Medicaid pharmacy policy to allow for 2 preventive inhalers to be dispensed at one time for Asthma Link patients | We are establishing an Asthma Link-specific policy with Medicaid pharmacy team to allow coverage of 2 inhalers for Asthma Link participants | |
c. Barrier: Family unable to bring the 2nd inhaler to school | |||
Families School nurses Medical providers | Pharmacists Practice managers | Recommends using free Mail-order delivery service to send medication from pharmacy to school | Practice trainings explain how to set up select families with mail-order delivery of medication from pharmacy to school |
d. Barrier: Delays with schools receiving faxed orders from practice staff | |||
School nurses | Practice managers | Practice managers recommend changing the workflow so orders are faxed immediately | Practice staff faxes orders as soon as phone call with school nurse is complete |
e. Barrier: School nurses reported some school may not have a nurse to administer medications | |||
School nurses | School administrators | Recommends identifying alternate professional at school capable of administering medications | Identify alternate officials in schools who can administer medications to children (e.g. health aid, counselor |
f. Barrier: School nurses reported some children did not consistently come to the nurse’s office | |||
School nurses | School administrators | Recommends providing a list of Asthma Link patients to principals/teachers so they can facilitate bringing child to health office | School nurse will provide principal, teacher with list of Asthma Link patients |
g. Barrier: No support for daily asthma therapy during school breaks or holidays | |||
School nurses Medical providers | Practice managers School administrators DPH Health insurers | Recommend developing a system to aid children during school breaks | Remote Asthma Link was created for when school is not in-session: daily text message to caregiver and remote weekly school health check-in |
h. Barrier: No established dissemination or sustainability protocol. At present school-supervised therapy is not widely adopted across the state or nation | |||
School nurses Medical providers | Legislators DPH Health insurers | Recommend partnering current Asthma Link clinic/school leaders and new clinic/school leaders (targeting districts with high asthma rates) to facilitate knowledge and trust in Asthma Link Recommended presenting data on healthcare utilization outcomes and cost reduction to support reimbursement for Asthma Link | Partner clinical/school leaders currently participating in Asthma Link with new clinical/school leaders to share their Asthma Link experiences –(disseminate to districts with high asthma rates) Asthma Link team will present outcomes and cost savings data to payers, legislators, DPH |