title: Steroid inhaler adherence, flu vaccine receipt, and race: associations with the quality of the parent-physician relationship for asthmatic children.
abstract: BACKGROUND
  Steroid inhaler adherence and influenza immunization rates are low for asthmatic minority children.
  
  
  OBJECTIVE
  To examine associations between parents' adherence to administering their child's steroid inhaler, influenza vaccine receipt, and parental perceptions of the primary care experience.
  
  
  METHODS
  In 2006 we interviewed parents of children aged 2-12 who had an asthma-related physician visit in 2004 and 2005 about steroid inhaler use and influenza vaccine receipt. Parents rated their child's doctor using the Primary Care Assessment Survey (PCAS).
  
  
  METHODS
  Outcome variables were inhaler adherence and influenza vaccine receipt. Independent variables included PCAS scores, child health measures, parental personal and financial stress, and demographic variables.
  
  
  RESULTS
  Children of inhaler-adherent parents were more likely to be immunized (OR, 2.94; p = .03). Black parents were less adherent to steroid use (OR, 0.37, p = .01) while nonblack/nonwhite children had lower vaccination rates (OR, 0.29, p = .02). Continuity of care was associated with better inhaler adherence (OR, 1.02, p = .01). Influenza immunization was associated with physician's knowledge of the child's medical history (OR, 1.02, p = .05), interpersonal skills (OR, 1.02, p = .03), and parental trust in the physician (OR, 1.03, p = .02). Minority parents gave lower ratings than white parents to their child's physician and office on characteristics associated with inhaler adherence and immunization.
  
  
  CONCLUSIONS
  Minority parents of asthmatic children are less adherent to recommended asthma treatments and rate physicians lower on characteristics associated with adherence. Improving those characteristics may improve asthma outcomes for minority children.
authors.affiliation: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor 48109, USA. klmosele@med.umich.edu
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Moseley
authors.forename: Ericka J
authors.initials: EJ
authors.lastname: Hudson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008297:Male; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D010290:Parents; D011368:Professional-Family Relations; D044469:Racial Groups / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D007252:Influenza Vaccines