Patient-provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD.
OBJECTIVE
Poor children's reliance on emergency facilities is one factor implicated in the rise of morbidity attributed to asthma. Although studies have examined doctor-patient communication during routine pediatric visits, little data are available about communication during emergency care. This study sought to describe communication during emergency treatment of childhood asthma to learn if a "patient-centered" provider style was associated with increased parent satisfaction and increased parent and child participation.


METHODS
This cross-sectional, observational study examined 104 children aged 4 to 9 years and their guardian(s) attending emergency departments in seven cities. Quantitative analysis of provider-family dialogue was performed. Questionnaires measured satisfaction with care, provider informativeness, and partnership.


RESULTS
Providers' talk to children was largely supportive and directive; parents received most counseling and information. Children spoke little to providers (mean: 20 statements per visit versus 156 by parents). Providers made few statements about psychosocial aspects of asthma care (mean: three per visit). Providers' patient-centered style with parents was associated with more talk from parents and higher ratings for informativeness and partnership. Patient-centered style with children was associated with five times the amount of talk from children and with higher parent ratings for "good care," but not for informativeness or partnership.


CONCLUSIONS
Communication during emergency asthma care was overwhelmingly biomedical. Children took little part in discussions. A patient-centered style correlated with increased parent and child participation, but required directing conversation toward both parents and children.
Wissow
L S
LS
Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA. Lwissow@jhsph.edu
Roter
D
D
Bauman
L J
LJ
Crain
E
E
Kercsmar
C
C
Weiss
K
K
Mitchell
H
H
Mohr
B
B
D001249:Asthma / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011203:Poverty; D011368:Professional-Family Relations; D014481:United States; D014505:Urban Population