Empowering Pediatric Asthma Patients
When young patients are referred to Eisner Pediatric & Family Medical Center’s Pediatric Asthma Clinic (PAC), they are greeted by a warm, friendly face who quickly reassures them that they are in good hands. He is Felix Dominguez, the case manager and asthma coordinator who works with pediatric asthma patients to get their disease under control.
“Patients come to me after the pediatrician has diagnosed asthma,” Dominguez explains. “My role is to spend time educating the child and the parents, then monitor to help them get the asthma under control. We develop a relationship. Everyone knows me by name. They’re not afraid to talk to me.”
(See Felix in the Pediatric Asthma Clinic video.)
Asthma Training, Kids’ Style
One prominent fixture in his office is a baby doll he uses for training. “People tease me about the baby doll, but I don’t care,” he smiles. “It works. It helps the younger children relax. I demonstrate on the doll. Then, I have them demonstrate on the doll. Then, they can demonstrate on themselves back to me.
“If the children aren’t taking the medication properly, it’s not doing them any good. Sometimes, I find that the parents don’t know the proper way to apply the medication, so the children aren’t taking it properly. We try different ways until we identify the child’s comfort level. Some children respond best to using a spacer. It disperses the medication more evenly, so it doesn’t feel harsh when it hits the back of the child’s throat. Other children respond better to the use of a spacer connected to a mask. The mask covers the nose and mouth and ensures the medicine goes to the right places. Different kids prefer different ways.”
Advocacy and Empowerment for the Children
“I feel different. I’m tired of this. People make fun of me.”
Dominguez has heard these words from too many children. He has a strong desire to advocate for them and empower them to live active, healthy lives.
Often, supporting the children means winning over the parents. After seeing their child experience an asthma attack, some parents become fearful about allowing them to play sports or engage in other physically demanding activities.
Felix tells of one mother who had two kids with asthma. One played soccer, and the other was on the basketball team. After their asthma was diagnosed, the mom said “No more sports.” Felix stepped in and talked with her, showed her videos about asthma, and gained her trust. Her kids both continued their sports, graduated, and are today in college living active lives.
He’s not afraid to recruit his success stories to persuade reluctant patients and parents when needed. “I have kids talk to other kids. ‘Mario, come in here. You have asthma but you’re still playing soccer, right?’ I have moms talk to moms. Sometimes, they can reassure other moms that it’s OK to let their kids play sports better than I can.”
“I don’t want to see children give up the things they love doing because they have asthma. I tell them, ‘I don’t want to see you in here. I want to see you out at the movies or in the community having fun.’”
Before coming to EPFMC, Dominguez worked in case management with adults, children, and teens who were diagnosed with ADHD, cerebral palsy, and other needs. After 10 years, including several at Goodwill Industries, he experienced burnout. He knew he needed to do something else.
“I wanted to focus on disease management and kids. People always complained about their clinics. I realized that people needed advocacy. EPFMC got a two-year grant to study best practices in asthma case management. I knew I wanted to be a part of this. When the grant ended, they hired me as a case manager.”
Today, he manages a caseload of about 300 children.
“We Are a Loving Clinic”
In addition to training, families often need other forms of support to control their child’s asthma. As the case manager, Felix is there to help. Typical needs include:
- Getting a doctor’s appointment
- Getting prescriptions refilled
- Accessing a nebulizer machine, which is used to dispense asthma medication
- Identifying food triggers
- Identifying environmental factors in the home that may be causing their child’s symptoms
Some patients are reluctant to allow people into their home to diagnose and fix environmental problems. PAC works with Los Angeles Healthy Homes when environmental conditions in their home are identified as contributors to their child’s asthma. Felix works with the families to convince them to allow the workers in to repair flooring, replace moldy carpets, and make other changes to create a healthier environment for the family. About 85 percent of the families agree.
Felix Dominguez is just one of the people who make up the Pediatric Asthma Clinic team. “This would not be a success without the providers,” he says. “They rotate shifts every three months to work in the Pediatric Asthma Clinic. This ensures that everyone increases their expertise in treating asthma. They appreciate my input. We have developed great relationships.”
“The PAC works. It absolutely works.
“We are a loving clinic. Everyone knows one another. We never send patients away without the medication they need, whether or not they can pay. We’re here for the children.”