A Comparative Multi-Site Case Study of the Implementation and Impact of a Stock Inhaler Protocol in Two School Districts in Tucson, Arizona

Abstract

A stock inhaler protocol for schools has been recommended as an important safety net for students who do not have access to personal quick-relief medication. The implementation process and impacts of the stock inhaler protocol in public school systems are not well defined in the literature. This comparative case study assesses the processes and impacts of stock inhaler implementations in two low-income, majority Hispanic public school districts in Tucson, Arizona. The implementation and impact assessments used simple quantitative usage data and extensive narrative data from meeting notes, email correspondences, and in-depth interviews to evaluate the implementation processes and impacts from the 2013-2017 school years. Legal and practical concerns were the primary barriers to stock inhaler adoption at the district level and implementation at the school level. The recognition of the students’ needs and lack of resources; challenges of care without quick-relief medications; supports from external asthma experts; and supports from a centralized district health services leadership were identified as facilitators of adoption and implementation. The stock inhalers were used in the majority of the schools included in the evaluation. The stock inhalers were favored by all interviewed stakeholders (n=78), except for one caretaker and one adolescent. School health staff reported that the stock inhalers improved school-based respiratory care; reduced time, opportunity, and resource losses; reduced psychological distress related to unexpected respiratory distress; provided a tool used to improve family/student respiratory care and asthma management; and allowed family/student reliance of the school’s stock inhaler. The improved school-based respiratory care; reduced psychological distress; and reduced time, opportunity, and resource losses were the most cited benefits of the stock inhalers. Stock inhaler protocols can provide reliable and immediate access to quick-relief medication for any individual who experiences respiratory distress at schools, dependent on the design of the protocol. Stock inhaler protocols can improve efficiency and effectiveness of school-based respiratory care when barriers to access and implementation are reduced. External stock inhaler supports – including supportive state laws, expert knowledge to adapt the protocol to fit the needs of the district/school, and provision of necessary medication and delivery device – can reduce barriers to adoption and implementation.