Caregiver education to promote appropriate use of preventive asthma medications: what is happening in primary care?
OBJECTIVE
To describe actions taken by providers at primary care visits to promote daily use of preventive asthma medication, and determine whether patient or encounter variables are associated with the receipt of asthma medication education.


METHODS
As part of a larger study in Rochester, NY, caregivers of children (2-12 years old) with asthma were approached before an office visit for well-child, asthma-specific or other illness care from October 2009 to January 2013. Eligibility required persistent symptoms and a prescription for an inhaled asthma controller medication. Caregivers were interviewed within two weeks to discuss the health care encounter.


RESULTS
We identified 185 eligible children from six urban primary care offices (27% Black, 38% Hispanic, 65% Medicaid). Overall, 42% of caregivers reported a discussion of appropriate preventive medication use, fewer than 25% received an asthma action plan, and 17% reported "ideal" medication education (both discussing proper medication use and completing an asthma action plan); no differences were seen upon comparing well-child and asthma-specific visits with other visits. Well-child and asthma-specific visits together were more likely, compared with other visits, to include a recommendation for a follow-up visit (43% versus 23%, p = 0.007). No patient factors were associated with report of preventive medication education.


CONCLUSIONS
Guideline-recommended education for caregivers about preventive-asthma medication is not occurring in the majority of primary care visits for urban children with symptomatic persistent asthma. Novel methods to deliver asthma education may be needed to promote appropriate preventive medication use and reduce asthma morbidity.
a Department of Pediatrics , University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.
Sean M
SM
Frey
a Department of Pediatrics , University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.
Maria
M
Fagnano
a Department of Pediatrics , University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.
Jill S
JS
Halterman
D000280:Administration, Inhalation; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006266:Health Education / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009518:New York; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*; D055502:Secondary Prevention; D014505:Urban Population
D018927:Anti-Asthmatic Agents
Control/management; education; pediatrics; prevention; therapy