Factors affecting primary care provider and caregiver concordance for pediatric asthma medications.
BACKGROUND
Lack of discussion regarding actual asthma medication use by physicians with caregivers of children with asthma may result in low caregiver and physician concordance about prescribed asthma medications.


OBJECTIVE
The primary objective was to examine the concordance between primary care providers (PCP) and caregivers regarding child asthma medication use.


METHODS
Current asthma medications in the home with verification from each child's PCP were obtained for 231 underserved children with persistent asthma. Kappas and chi-square statistics were calculated to measure the strength of the concordance. Caregiver and PCP dyads were categorized as concordant or discordant based on asthma medication use.


RESULTS
For all asthma prescriptions N = 479, two thirds of caregiver-PCP dyads (67.8) were categorized as concordant with at least one asthma medication. Concordance for asthma medications varied by type of medication ranging from 84% agreement for albuterol and 77% agreement for Flovent. In the final regression model predicting caregiver and PCP concordance, the number of PCP visits within the past 6 months and caregiver report of no limitation of child's activity due to asthma were significantly higher in caregivers who were considered concordant with their child's PCP while controlling for child age and frequency of symptom nights and number of ED visits in prior 6 months. In a model predicting the number of PCP visits, the number of ED visits was the only significant variable associated with the number of PCP visits while controlling for caregiver and PCP concordance.


CONCLUSIONS
Caregiver and PCP concordance was significantly associated with increased number of PCP visits suggesting that increased exposure to a health care provider may increase agreement between a child's PCP and caregiver regarding prescribed asthma medications. However, there may be other important factors including increased emergency department visits that may also be associated with subsequent pediatric primary care visits for asthma.
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. abutz@jhmi.edu
Arlene
A
Butz
M Denise
MD
Sellers
Cassia
C
Land
Jennifer
J
Walker
Mona
M
Tsoukleris
Mary Elizabeth
ME
Bollinger
D001741:Black or African American; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D017028:Caregivers; D002648:Child; D003266:Continuity of Patient Care; D004363:Drug Utilization; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010821:Physicians, Family; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014505:Urban Population
D018927:Anti-Asthmatic Agents