Flow Chart 1: Typical Initial Asthma Clinic Visit

Initial Intake
  • Family Registers
    • Family fills out any paperwork not already completed
  • Registration clerk verified insurance and
  • Collects forms (if mailed out before appointment)
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Community Health Worker (CHW): (10 to 15 minutes)
  • Greets the family, introduces him/herself and explains the CHW role
  • Orients family to the asthma program. Purpose of the program is to get child’s asthma under control and to learn or refine asthma self-management skills. Referred by a primary care provider, asthma team partners with the primary care provider, and the family returns to the primary care provider after completing the program. Discusses clinic visits, home visits and phone follow up, confidentiality, emphasizes that it is the family’s choice to participate
  • Explains to family what to expect today and approximately how long today’s appointment will take
  • Elicits and addresses any questions about the program or today’s visit
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Clinical case manager or medical assistant: (20 minutes)
  • Obtains an asthma health history on the child using the Intake Form
  • Identifies social barriers and needs
  • BP, height and weight
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Family watches “Your Child and Asthma” video: (18 minutes)
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Clinical case manager and/or medical assistant: (20 minutes, if child is over age 5)
  • Peak flow (observe technique and provide coaching)
  • Perform spirometry
  • Give 2-4 puffs of albuterol per MD/NP order (observe technique & provide coaching) wait 20 min. before doing a post bronchodilator spirometry
  • Allergy skin testing (multitest for mite, cockroach, cats, dogs, indoor mold, local grasses per MD/NP order and protocol)
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Clinical case manager and/or medical assistant (10 min)
  • Do post bronchodilator spirometry
  • Read skin test results
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Clinical case manager (10-15 minutes)
  • Elicits child’s/families issues/concerns about their asthma; addresses identified issues and concerns
  • Elicits and answers any questions about video, tailors instruction to family’s needs; provides asthma education materials
  • Clarifies information on patient forms as needed
  • Discusses allergen triggers and helps to identify other triggers and trigger avoidance measures. If family is ready to implement 1 or 2 changes to decrease exposure to triggers, help family set goals
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Clinician (15 minutes)
  • Reviews forms and test results
  • Performs physical assessment
  • Confirms diagnosis
  • Determines asthma severity
  • Interprets spirometry
  • Initiates or adjusts medications as needed
  • Gives Rx for medications, meter and spacer as needed
  • Develops written Asthma Action Plan and teaches family how to use it
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CHW (6 to10 minutes)
  • Schedules home visits in1or 2 weeks
  • Schedules next asthma clinic visit
  • Answers any questions about asthma, and the asthma program
  • Discusses next steps on social needs identified
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Case conference to develop care plan for each family

Each member of the asthma team acquires some information about the family and the child’s asthma that is important to the development of a sound asthma care plan. The asthma team holds a case conference once a week to share information and develop or revise a care plan for each family who visited the clinic that week.

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