Self-reported Adherence, Management Behavior, and Barriers to Care After an Emergency Department Visit by Inner City Children With Asthma

Leickly, Frederick E.; Wade, Shari L.; Crain, Ellen F.; Kruszon-Moran, Deanna; Wright, Elizabeth C.; Evans, Richard

doi:10.1542/peds.101.5.e8

Cited by 136 publications

(113 citation statements)

References 28 publications

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“…Even after 2 weeks, less than half of the study subjects had either completed or made an appointment with their regular asthma care provider. These disappointing follow-up results again are similar to those reported previously [18][19][20][21][22] and occurred despite considerable efforts on behalf of the ED staff to facilitate such follow-up visits; these efforts included informing the accompanying adult to make a follow-up appointment, faxing a copy of the dictated medical chart to the regular asthma care provider, and identifying a medical provider and making an immediate referral for the minority of patients who did not have a PCP.…”

Section: Discussionsupporting

confidence: 74%

“…9,10,15,16,18 For example, many children who use the ED seem to be undermedicated in terms of using an inhaled corticosteroid (ICS) or other long-term control medication, 8,10,11,16,17 and follow-up visits with a primary care provider (PCP) usually occur much later than the time frame recommended in the NAEPP guidelines. [19][20][21][22] Here we describe the characteristics of children treated for an acute asthma exacerbation in 3 EDs in western Michigan (selected to represent urban, suburban, and rural settings) and report on several quality indicators of care and management based on NAEPP guidelines. …”

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confidence: 99%

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Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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Section: Discussionsupporting

confidence: 74%

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confidence: 99%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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“…20 Lack of time during an encounter is frequently cited as the main reason for poor communicationparticularly pertaining to patient preferences, quality of life, and psychosocial factors 17 -and is more often the case during unscheduled acute care visits. 20 Given that inner-city families often do not make or keep preventive care visits, even after an ED encounter, 28 they may be at greater risk for poor physiciancaregiver communication. Therefore, poor communication may be a contributing factor to the increased morbidity seen in inner-city children with asthma.…”

Section: Discussionmentioning

confidence: 99%

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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“…Similar concerns about dependence have been observed among other populations as well. 4,13 Because bronchodilators were perceived as being immediately effective, these drugs were used by most of the respondents. These perceptions and behaviors seem to contribute to the low level of use of controller medications: only one third of participants (34%) reported use of inhaled steroids or other antiinflammatories for their asthma.…”

Section: Discussionmentioning

confidence: 99%

“…One study found that only 23.5% of inner-city children who had presented at an ED for their asthma were using antiinflammatory medications. 13 A schoolbased study of medication use among inner-city asthmatics reported that only 11% took some form of daily antiinflammatory medication. 15 Even in a managed care population, bronchodilators dominated asthma treatment, and less than one third of asthma patients received any antiinflammatory medications.…”

Section: Discussionmentioning

confidence: 99%

Navajo Perceptions of Asthma and Asthma Medications: Clinical Implications

Sickle

Wright

2001

Pediatrics

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ABSTRACT. Background. Despite the large number of asthma patients, relatively little is known about the beliefs of asthmatic children and their parent(s), or the extent to which these beliefs influence management of the disease.Objective. The purpose of this study was to examine how medication-taking and the use of health care services were influenced by perceptions of the disease and beliefs about medications among Navajo families.Methods. Ethnographic interviews were used to investigate the disease and medication beliefs of 22 Navajo families with 29 asthmatic children.Results. Most respondents perceived asthma as the transient experience of symptoms in someone who was chronically vulnerable to breathing problems. The majority (97%) of these asthmatics reported using bronchodilators, although only 34% reported current use of antiinflammatory medications. Although controller medications were distinguished from rescue medications, they were thought to have the same effect on the lungs. Many families were concerned about becoming dependent on the medicines and attempted to "wean" the asthmatic from the drugs. A large proportion (80%) of children had assumed responsibility for their own medication taking. Parents often referred to previous attacks requiring treatment in the emergency department when deciding whether to initiate medication or seek medical attention, often resulting in a delay of treatment. Nebulized treatments delivered in the emergency department were perceived to be the strongest therapy available. As a result, visits to the emergency department were common (79%), as were hospital admissions (57%).Conclusion. This study provides evidence that, among pediatric Navajo asthma patients, perceptions of asthma and beliefs about the activity of asthma medications influence when and how often asthma medicines are taken, as well as the use of health care services. In addition, excessive reliance on emergency treatments and the high rates of hospital admissions suggest that asthma is undertreated in this group of Navajo patients. Pediatrics 2001;108(1). URL: http://www.pediatrics.org/ cgi/content/full/108/1/e11; asthma, Native Americans, Navajo, perceptions, treatment, medication, health utilization.ABBREVIATION. ED, emergency department.

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Self-reported Adherence, Management Behavior, and Barriers to Care After an Emergency Department Visit by Inner City Children With Asthma

Cited by 136 publications

References 28 publications

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

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

Navajo Perceptions of Asthma and Asthma Medications: Clinical Implications

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