Treatment adherence among low-income, African American children with persistent asthma.

OBJECTIVE: The study aims to assess medication adherence and asthma management behaviors and their modifiable predictors in low-income children with persistent asthma. METHODS: The authors conducted a cohort study of 143 children ages 6 to 11 prescribed a daily inhaled controller medicine that could be electronically monitored. Children were recruited from clinics or the emergency department of an urban children's hospital. Data were collected at baseline (T1) and 1 year later (T2). Outcome measures were adherence to controller medications as measured by electronic monitoring devices, observed metered-dose inhaler and spacer technique, exposure to environmental tobacco smoke, and attendance at appointments with primary health care provider. RESULTS: Medication adherence rates varied across medications, with higher rates for montelukast than for fluticasone. Eleven percent to 15% of children demonstrated metered dose inhaler and spacer technique suggesting no drug delivery, and few (5% to 6%) evidenced significant exposure to environmental tobacco smoke. Less than half of recommended health care visits were attended over the study interval. Few psychosocial variables were associated with adherence at T1 or in the longitudinal analyses. Fluticasone adherence at T2 was predicted by caregiver asthma knowledge. CONCLUSIONS: A substantial number of low-income children with persistent asthma receive less than half of their prescribed inhaled controller agent. Patients without Medicaid, with low levels of caregiver asthma knowledge, or with caregivers who began childrearing at a young age may be at highest risk for poor medication adherence.

Family Evaluation Clinic: Training Psychiatrists to Think Systemically.

A family evaluation training program, Family Evaluation Clinic (FEC), was conducted in an outpatient child psychiatry clinic serving a low-income, African-American, urban population. To determine the success of the program in meeting its training goals, the authors reviewed patient attendance rates and collected survey data from trainees who participated in evaluations conducted between 1994 and 2000. Patient attendance rates were high, and trainees indicated that the program was helpful and valuable to them in their current practice. The authors discuss advantages and disadvantages of FEC as a training method and share recommendations for future family evaluation training in a general residency program.