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British-trained physician wants to empower parents to manage asthma problems in their children

This article first appeared in the St. Louis Beacon, May 23, 2012 - Dr. Jane Garbutt may be on the trail of a complex and effective low-tech approach to helping parents do better jobs in handling asthma in their children.

Since 2008, she has headed up a large trial at Washington University to determine whether offering advice and recommendations through telephone calls from trained coaches might eventually help parents to manage the disease.

"We are hoping this study will lead to better care and that it will be cheaper," she says.

Doctors, patients and others like the coaching program, she says, but adds that the U.S. health-care system offers no way to pay the coaches "even though they might well be a lot cheaper than (children with asthma) going to the emergency room." 

ER care for asthmatic children is costly. Data from the Missouri Department of Health and Senior Services show 29,600 ER visits and 8,200 hospitalizations relating to asthma in Missouri in 2009, with the cost of care exceeding $37 million.

Garbutt's project involves 950 area families and 22 pediatric offices, with half of the families having access to a coach and the other half without. Researchers want to know if families that were coached ended up being wiser in how they used resources and cared for children with asthma. Garbutt is wrapping up the fourth year of the five-year study and hopes to have some results in about six months.

Asked if she expected the findings to show promise, she said, "Absolutely! We're getting all kinds of stories from the mothers indicating that it has really made a difference. They say the coach has changed their lives and that the child is no longer missing school because the mother now knows how to care for asthma."

Although treatments for asthma are widely available, Garbutt says one problem is that many families don't know how to use the medicine effectively. In addition, she says, addressing some cases of asthma is complicated by the fact that some victims also have allergies.

"When the allergies get bad, the asthma also gets bad. When children have colds, the asthma gets bad. The asthma has peaks and valleys. So when the child seems to be doing well, the parents often stop the medications but don't start them soon enough to be effective."

She adds that day-to-day management of asthma is difficult. "You have to be on your game all the time. So the coaches are there to train, teach the moms, empower them, encourage them to go to the doctor when they need to, use the medication every day and react when a kid's symptoms get worse."

Garbutt's perspective about medicine has been shaped in part by her background and training. Born in Southport, England, about 20 miles from Liverpool, she got her initial medical training at the University of Bristol. The family moved to Toronto and still later to St. Louis because the accounting firm where her husband worked required him to relocate. She eventually joined the Washington University School of Medicine where she is now an associate professor.

Along the way, she created a research network called the Washington University Pediatric and Adolescent Ambulatory Research Consortium. It represents her collective approach to research by bringing together 66 pediatricians and five nurse practitioners from nearly three dozen practices in the St. Louis area.

She takes a holistic approach to medicine, which shaped how she studied asthma. She says the approach is similar to "medical homes" in which outreach workers are used to help people take better care of themselves, follow the doctor's orders and better manage their illnesses. She says the approach reminds her of medicine in England when she lived there in the late '70s.

"We had nurses who did home visits. They were an extension of the doctors. They would administer treatment, see what was going on with the patient and give the information to the doctor. Everybody was on the same team."

Asked if she sensed many differences in the way medicine is practiced in the U.S. compared to England. "One thing I noticed (in England), and I think it's still true today, is people's willingness to accept responsibility for their own health.

"People here tend to go to the doctor more, looking for a quick fix. But in the UK, there is more of an expectation that you don't go unless it's something you haven't figured out how to fix yourself."

She says her interest is in improving care. 

"Sometime we use too much of a good thing and sometime we don't use enough of it, including the over use of antibiotics and the under use of effective asthma medications. I'd like to know how we can tackle those problems."

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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