title: Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children with Asthma.
abstract: Underuse of controller medicines among children with asthma remains widespread despite national guidelines.
  
  
  
  To (1) assess provider prescribing patterns for asthma controller medications; (2) assess how frequently parents' reports of their child's asthma controller medicine use were mismatched with their provider's recommendations; and (3) evaluate parent attitudes and demographic characteristics associated with these mismatches.
  
  
  
  In this cross-sectional study, we conducted linked surveys of parents and providers of children with probable persistent asthma in a Medicaid program and 4 commercial health plans in 2011. Probable persistent asthma was defined as a diagnosis of asthma and 1 or more controller medication dispensing.
  
  
  
  This study included 740 children (mean age, 8.6 years). Providers for 50% of the children reported prescribing controller medications for daily year-round use, 41% for daily use during active asthma months, and 9% for intermittent use for relief. Among parents, 72% knew which class of controller medication the provider prescribed and 49% knew the administration frequency and the medication class. Parents were less likely to report the same controller medication type as the provider, irrespective of dose and frequency, if they were Latino (odds ratio [OR], 0.23; CI, 0.057-0.90), had a household smoker (OR, 2.87; CI, 0.42-19.6), or believed the controller medicine was not helping (OR, 0.15; CI, 0.048-0.45).
  
  
  
  Mismatches between parent reports and providers intentions regarding how the child was supposed to use inhaled steroids occurred for half of the children. Efforts should focus on ways to reduce mismatches between parent and provider intentions regarding controller medication use.
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: ann.wu@childrens.harvard.edu.
authors.forename: Ann Chen
authors.initials: AC
authors.lastname: Wu
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.affiliation: Harvard Medical School, Boston, Mass; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Mass.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minn.
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Larkin
authors.affiliation: Center for Clinical Outcomes & Research - Southeast, Kaiser Permanente Georgia, Atlanta, Ga; The Argus Group, Hamilton, Bermuda.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass.
authors.forename: Alison
authors.initials: A
authors.lastname: Galbraith
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.affiliation: Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tenn.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Kelly
authors.initials: K
authors.lastname: Horan
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006282:Health Personnel; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008297:Male; D010290:Parents; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists
keywords: Adherence; Asthma; Children; Controller medications; Provider