title: Preventive asthma care delivery in the primary care office: missed opportunities for children with persistent asthma symptoms.
abstract: OBJECTIVE
  To describe which National Heart Lung and Blood Institute preventive actions are taken for children with persistent asthma symptoms at the time of a primary care visit and determine how care delivery varies by asthma symptom severity.
  
  
  METHODS
  We approached children (2 to 12 years old) with asthma from Rochester, NY, in the waiting room at their doctor's office. Eligibility required current persistent symptoms. Caregivers were interviewed via telephone within 2 weeks after the visit regarding specific preventive care actions delivered. Bivariate and regression analyses assessed the relationship between asthma symptom severity and actions taken during the visit.
  
  
  RESULTS
  We identified 171 children with persistent asthma symptoms (34% black, 64% Medicaid) from October 2009 to January 2011 at 6 pediatric offices. Overall delivery of guideline-based preventive actions during visits was low. Children with mild persistent symptoms were least likely to receive preventive care. Regression analyses controlling for demographics and visit type (acute or follow-up asthma visit vs non-asthma-related visit) confirmed that children with mild persistent asthma symptoms were less likely than those with more severe asthma symptoms to receive preventive medication action (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.14-0.84), trigger reduction discussion (OR 0.39, 95% CI 0.19-0.82), recommendation of follow-up (OR 0.40, 95% CI 0.19-0.87), and receipt of action plan (OR 0.37, 95% CI 0.16-0.86).
  
  
  CONCLUSIONS
  Many children with persistent asthma symptoms do not receive recommended preventive actions during office visits, and children with mild persistent symptoms are the least likely to receive care. Efforts to improve guideline-based asthma care are needed, and children with mild persistent asthma symptoms warrant further consideration.
authors.affiliation: Department of Pediatrics and the Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY 11642, USA. alisonbayer.yee@gmail.com
authors.forename: Alison B
authors.initials: AB
authors.lastname: Yee
authors.forename: Maria
authors.initials: M
authors.lastname: Fagnano
authors.forename: Jill S
authors.initials: JS
authors.lastname: Halterman
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000517:prevention & control* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D012044:Regression Analysis; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents