Med school

As patient loads grow and physicians have less time to devote to each of their patients, the health education component of care sometimes gets pushed to the wayside. To increase disease awareness and encourage patients to be proactive about their health, several local clinics have established educational outreach programs and services.

Most recently, the Vancouver-based Allergy and Asthma Center of Southwest Washington has sponsored a new center focused solely on asthma education. The Asthma Education Center of the Northwest opened at the end of January and is the first of its kind regionally.

“We don’t have the time to guide patients as we would like to, and we’re specialists,” said allergist Jason Friesen, who practices at the Allergy and Asthma Center of Southwest Washington. “The education center is not only providing a service to the patients but to the medical community as well. We hope this is where health care is headed in the future.”

The clinic invested heavily in the education center, which is built around an intensive one-year program with a possible one-year follow-up. The first year includes an initial one-hour intake visit and up to five follow-up visits. Another visit takes place at the end of the second year. Not all clients will require the full two years.

The goal is to increase self-management and control of asthma, decreasing unnecessary visits to clinics, urgent care centers and emergency departments, said Center Director Cindy Cooper, who is a registered nurse and certified asthma educator.

Cooper works one-on-one with patients and their health care providers, families, caregivers, schools and hospitals to help them understand asthma as a chronic disease, their personal asthma triggers and how to prevent them, and developing an “asthma action plan.”

“It’s four to seven hours of education alone,” Cooper said. “It’s an intense first year, and they learn how to self-manage the disease.”

She may go into a client’s home or school to look at the environments and make recommendations as to avoiding asthma attacks. The Allergy and Asthma Center of Southwest Washington’s three doctors – Friesen, Carolyn Comer and Michael Noonan – are on board as “allergist coaches,” to be on-call for Cooper with feedback and guidance. Care is centered on the recently updated National Asthma Education and Prevention Program’s evidence-based guidelines for the diagnosis and management of asthma.

Clients do not have to be referred to the education center, but they do need to be under the care of a physician, no matter where the doctor practices.

Seeing results

“In this day and age, education is everything to the patient,” said Kathy Cushman, a licensed practical nurse at Vancouver-based Family Medicine of Southwest Washington. “We like the patient to be able to come to us and tell us what they need.”

The physician group has created an outreach program for diabetic patients that includes visits with a diabetic nurse every three months, followed up with a meeting with their doctor. The visits monitor the patient’s immunizations and eye exams, and ensure their lab work is up to date. It is an opportunity to give them extra information about the disease and answer questions, Cushman said.

The clinic also facilitates monthly group meetings for patients where doctors, nurses, a psychologist, nutritionist, podiatrist and pharmacist are on-hand to answer questions.

“The patients are a great support to one another, and often great resources,” Cushman said.

Clinic Supervisor Marilyn Novak said about 700 of the clinic’s 12,000 patients have diabetes, and the program has noticeably increased participants’ health. Their overall weight, blood pressure, blood sugar and kidney functions are improving.

“People with diabetes are often in denial and choose not to address it very well,” Novak said. “What we’ve figured out is that diabetic patients use up a lot of medical resources, but it’s better if we can get them connected to their disease. Either they control it or it controls them.”

A cost is associated with the program only if a patients’ insurance provider requires a co-pay.

The Kaiser Permanente network provides a number of educational outreach services, including weight management, smoking cessation, stress management and childbirth education.

Lonnie Isaacson is a registered dietician who is part of Kaiser’s health education team and teaches the Freedom From Diets weight management program at the Salmon Creek and Cascade Park clinics.

The 12-week program, which is open to the public, is research-based and designed to help people overcome barriers to weight management, including pain, time, stress and lack of support, said Isaacson, who also conducts obesity research at Kaiser’s research center.

She has seen participants decrease their reliance on medication, improve blood pressure and control their weight. A number of individuals who had planned on gastric bypass surgery made significant lifestyle changes and opted out of the procedure.

“Knowledge is so important to making informed decisions,” Isaacson said. “It’s beyond dispensing information, you’re helping people with the process of behavior change.”  

Changing mindsets

To test its program, the Asthma Education Center of the Northwest ran a small pilot program with patients from the allergy and asthma center. Five patients of various ages took part – one of whom is Cooper’s teenage son.

“We learned it works,” Cooper said.

The cost of visits to the education center will be treated as other medical visits – it will be clarified whether the visit is covered by the client’s insurance up-front.

Getting the word out to regional primary care clinics, urgent care centers and emergency departments has been a challenge.

“They’re curious, but not sure what to make of the program,” Cooper said. “I think really showcasing the time element will make a difference.”

In the primary care setting, asthma education often takes place in clinic exam rooms in a short period of time. Even in the specialty clinics, patients may become overwhelmed by a great amount of information in a short period of time, Comer said.

“They’re saturated,” she said. “We think by having clients come to a scheduled meeting where they know they’re going to receive information, they’ll be mentally ready to learn and retain more.”

The allergists said they expect the education center to be popular with newly diagnosed people, who tend to want to learn as much about the disease as possible. Life-long asthma patients who think symptoms are just a part of life may take more convincing.

Although the education center has its own address and signage, it is reliant on the clinic for funding, but the goal is to build it into a standalone business.

 “Most physicians don’t have a lot of time to do a great deal of education, but proactive care is probably the reason I became a dietician – I’ve always thought it’s better to prevent a heart attack than treat it later,” Isaacson said.

“It reduces pain and suffering, which is ultimately the mission of all health care, and it reduces costs. If you can avoid a costly bypass surgery, that keeps costs down and helps out everybody else who is part of that health care system.”

Megan Patrick-Vaughn can be reached at