Asthma is the most common chronic disease affecting US children. For those with persistent symptoms, optimal asthma symptom control is predicated on children taking daily control medications. Both national and international consensus groups recommend inhaled corticosteroids as the most effective asthma control medication. However, adherence to asthma control medications in children is consistently reported as poor across all control medication classes. The most common reasons for non-adherence to asthma control medications are parental distrust of asthma control medication and concerns over adverse events, especially growth velocity and final adult height. Since general medical providers rather than specialists treat most asthmatic children, it is important to study how general pediatricians communicate about the risks and side effects of asthma control medications. The proposed research is a secondary data analysis of survey and clinic visit audio - tapes that were collected in five rural general pediatric practices from 2006 through 2009 including 35 pediatricians and 296 of their patients with persistent asthma symptoms. Quantitative analyses employing generalized estimating equations will be conducted to examine the influence of child, caregiver, pediatrician, and medication characteristics on discussions of benefits, risks, and side - effects of asthma control medications. In addition, the proposed research will also examine how the above characteristics and discussions about benefits, risks, and side - effects affect control medication adherence one month after the initial audio - taped visit. The study will also qualitatively describe the risk communication that occurs during the visits. Understanding how pediatricians communicate with children and their caregiver(s) about the benefits, risks, and side - effects of asthma control medication will enable researchers to develop interventions that can improve communication during a pediatric office visits. However, very little is known about pediatrician- caregiver-child communication about asthma control medications. Risk communication research is a priority of the Food and Drug Administration and medication safety is a research priority of the Agency of Healthcare Research and Quality further highlighting the importance of this proposed research. Data from the proposed research could inform intervention strategies designed to improve patient-physician communication about the risks and benefits of asthma control medications. Such interventions have the potential to improve adherence to these medications and subsequently: (1) reduce absenteeism from school, (2) increase symptom - free days, (3) decrease asthma emergency department visits, and (4) reduce time lost from work for caregiver(s).

Public Health Relevance

Asthma is the most common chronic health condition affecting US children. One of the Food and Drug Administration's research priorities is risk communication. This proposed research will examine how medical providers in general pediatric clinics discuss the risks, side effects, and benefits of asthma controller medications with primary caregivers and children by analyzing transcripts of audio taped asthma visits. This proposed research will then explore whether those discussions are related to asthma controller medication adherence one month after the audio taped asthma visit.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Harding, Brenda
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University of North Carolina Chapel Hill
Schools of Pharmacy
Chapel Hill
United States
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Gillette, Chris; Blalock, Susan J; Rao, Jaya K et al. (2014) Provider-caregiver-child discussions about risks associated with asthma control medications: content and prevalence. Pediatr Pulmonol 49:727-33