Adherence and morbidity following emergency department care among inner-city children with asthma.
OBJECTIVE
To explore the utility of two measures, Risk for Nonadherence (RN) and Admitted Nonadherence (AN), developed in a national sample of children with chronic asthma, for predicting short-term morbidity among children following a pediatric emergency department (PED) visit for acute asthma and to compare verbal and self-completion of these measures.


METHODS
Prospective cohort study of children 3 to 11 years of age presenting to a PED with an acute asthma exacerbation. Caretakers were randomized to self-completion of a questionnaire assessing RN and AN or to verbally respond to the same questionnaire administered by a research assistant. Five asthma morbidity indicators were collected at 2, 4, and 8 weeks following discharge from the PED.


RESULTS
One hundred fifty-four patients were enrolled. There were no significant differences in asthma severity, RN, or AN, or the number of items missing on questionnaires between the self-completion and verbal administration groups. Patients with a RN score >4 had an adjusted odds of 3.67 (95% confidence interval [CI] 1.57-8.58) for waking >2 nights due to asthma symptoms. The adjusted odds of patients with any AN to report needing >4 days of rescue asthma medication was 3.16 (95% CI 1.37-7.26).


CONCLUSIONS
RN and AN were both associated with morbidity indices following an acute asthma exacerbation and can identify children at risk for increased short-term morbidity regardless of the method of questionnaire administration. Assessment of RN and AN by self-administered questionnaire during an ED visit for asthma maybe feasible.
Kunkov
Sergey
S
Division of Pediatric Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. sergey.kunkov@gmail.com
Crain
Ellen F
EF
D017677:Age Distribution; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity / Q000639:trends; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011203:Poverty; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014505:Urban Population
D018927:Anti-Asthmatic Agents