Providers Underestimate Symptom Severity Among Urban Children With Asthma

Halterman, Jill S.; Yoos, H. Lorrie; Kaczorowski, Jeffrey M.; McConnochie, Kenneth M.; Holzhauer, Robert J.; Conn, Kelly M.; Lauver, Sherri; Szilâgyi, Peter G.

doi:10.1001/archpedi.156.2.141

Cited by 120 publications

(74 citation statements)

References 24 publications

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“…[4][5][6] However, health care providers do not routinely follow asthma guideline recommendations, 7,8 resulting in substandard care and poor health outcomes. [9][10][11][12][13][14] One of the shortcomings of asthma guidelines is the limited extent to which health care providers are provided with tools to follow the recommended care. 15 There have been provider-targeted interventions, [16][17][18][19][20][21] but most interventions have been patient-focused.…”

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confidence: 99%

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Butz²,

et al. 2013

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BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-forperformance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. METHODS:CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. Pediatrics 2013;132:517-534

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confidence: 99%

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Butz²,

et al. 2013

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“…[2][3][4][5][6] Current guidelines from the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP) 7 recommend daily use of an antiinflammatory medication for children with persistent asthma symptoms. Many studies, however, document undertreatment of asthma, particularly among inner-city children, as measured by caregiver report, 8,9 physician report, 9 pharmacy refill data, 10 and insurance claims data. 11 Undertreatment of asthma can affect health outcomes.…”

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confidence: 99%

“…Previous research has shown that among children with persistent asthma symptoms, only 50% were prescribed a maintenance medication by their physician. 9 Moreover, it has been documented that nearly one third of preventive medications prescribed are not filled within 1 year of the medical encounter. 13,14 Even when a prescription is filled, patient adherence to the regimen is typically poor.…”

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confidence: 99%

“…The underuse of controller medication may be attributable to poor caregiver-physician communication about the severity of asthma symptoms, 9 the prescribed regimen, 17 or other medications that the patient is using. 18 Patient-physician communication can influence health outcomes, including satisfaction with care, recall and understanding of medical infor-mation, quality of life, and even health status.…”

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confidence: 99%

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Caregiver-Physician Medication Concordance and Undertreatment of Asthma Among Inner-City Children

et al. 2003

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ABSTRACT. Objective. To assess the extent to which caregivers and their child's physician agree about the prescribed asthma medication regimen and evaluate factors associated with medication concordance.Methods. A cross-sectional, descriptive survey was administered to 318 caregivers of inner-city children with asthma, aged 5 to 12 years, and their caregiver-identified primary care physician at elementary schools and participants' homes. Concordance between caregiver-and physician-reported controller medication prescription was measured.Results. Only 42% of physicians and 32% of caregivers reported a controller medication prescription (78% agreement, ‫؍‬ 0.54; 95% confidence interval: 0.45-0.63) despite that 73% of the children were rated by their caregiver as currently experiencing persistent asthma symptoms. When the physician reported a controller prescription, 38% of the caregivers denied use of a controller. Having a course of oral steroids in the past year ( 2 ‫؍‬ 9.85) and positive caregiver beliefs toward asthma care ( 2 ‫؍‬ 18.40) were associated with caregiver-physician concordance. Multivariate analysis found that when caregivers had high Asthma Beliefs Scale summary scores versus low scores, they were almost 10 times as likely to be concordant with the physician (odds ratio: 9.76; 95% confidence interval: 2.85-33.46).Conclusions. Our data support previous reports of physician underprescribing of controller medication among inner-city children. However, even when prescribed by a physician, more than one third of caregivers did not report a controller prescription, and this discordance was related to caregivers' beliefs about treatment. Efforts to improve physician adherence to asthma guidelines will not result in proper treatment unless caregiver-physician communication about asthma therapy is improved. Pediatrics 2003;111:e214 -e220. URL: http://www.pediatrics.org/cgi/content/full/111/3/e214; attitudes, beliefs, adherence, compliance.

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“…Effective preventive asthma care requires the parent or child to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the PCP (8)(9)(10). In the past, parents have been the main communicator with the PCP and the child has been almost entirely ignored during medical visits resulting in the medical interaction dominated by the physician and parent (11).…”

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confidence: 99%

Improving Asthma Communication in High-Risk Children

et al. 2007

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Few child asthma studies address the specific content and techniques needed to enhance child communication during asthma preventive care visits. This study examined the content of child and parent communications regarding their asthma management during a medical encounter with their primary care provider (PCP). The majority of parents and children required prompting to communicate symptom information to the PCP during the clinic visit. Some high-risk families may require an asthma advocate to ensure that the clinician receives an accurate report of child's asthma severity and asthma control to ensure prescribing of optimal asthma therapy.

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Providers Underestimate Symptom Severity Among Urban Children With Asthma

Cited by 120 publications

References 24 publications

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Caregiver-Physician Medication Concordance and Undertreatment of Asthma Among Inner-City Children

Improving Asthma Communication in High-Risk Children

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