Child- and caregiver-reported problems and concerns in using asthma medications.

OBJECTIVES: The purpose of the study was to (a) describe the types of medication problems/concerns that asthmatic children and their caregivers reported and (b) examine the association between child and caregiver demographic and sociocultural characteristics and reported asthma medication problems/concerns. METHODS: Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at five pediatric practices in nonurban areas of North Carolina. Children were interviewed and caregivers completed questionnaires after their child's medical visits about reported problems/concerns in using asthma medications. Multivariate logistic regression was used to analyze the data. RESULTS: Three hundred and twenty children were recruited. Eighty-seven percent of the children reported a problem or concern in using their asthma medications. Approximately 40% of children reported side effects and a similar percent stated that it was hard to understand the directions on their medicines; in addition 60% reported that it was hard to remember when to take their medicines. Females and non-White children were significantly more likely to report they were not sure how to use an inhaler than males and White children. Younger and non-White children were significantly more likely to report it was hard to understand the directions on their medicines than older and White children. Caregivers were most likely to report that their children were bothered a little or a lot by side effects (31%) and a similar percent (29%) were not sure their children were using their inhalers properly. Caregivers without Medicaid were significantly more likely to report difficulty paying for the asthma medications. CONCLUSIONS: Medication side effects are a significant problem area for both children and their caregivers, and inhaler skill-based training is particularly needed for non-White children. Health care providers should discuss with children and their caregivers the types of problems/concerns that children may have when using their asthma medications.

Preventive drug lists as tools for managing asthma medication costs.

OBJECTIVES: Preventive drug lists (PDLs) are a value-based insurance design intended to help high-deductible health plan (HDHP) members by covering preventive medications at lower or no cost before deductibles are met. Because little is known about members' experiences using this new tool, we sought to evaluate benefits and challenges of using PDLs to manage asthma costs. STUDY DESIGN: Qualitative interview study. METHODS: In 2018, we conducted telephone interviews with US adults (n = 22) who (1) were in HDHPs with PDLs and (2) had asthma and/or a child with asthma. We analyzed data using thematic content analysis. RESULTS: Some members reported that PDLs provided financial benefit and facilitated adherence to preventive medications. Others experienced barriers to using PDLs. Notably, some PDLs did not include members' asthma medications or provided only modest cost coverage due to restrictions in underlying formulary structures. Members who were aware of having a PDL sometimes worked with their providers to switch to listed medications. However, many members were not aware of having a PDL. Finally, because PDLs did not cover nonmedication costs, some members still struggled to afford asthma care. CONCLUSIONS: PDLs are a promising tool for helping families in HDHPs manage their medication costs and, in turn, their asthma. However, given current limitations in coverage, members must be aware of the benefit to seek out listed medications, and they may still struggle with the remaining cost sharing. Attention to implementation, including member outreach and education, is likely needed to realize the full potential of PDLs.

Funding, technical assistance, and other resources for school-based health centers.

To facilitate the successful implementation of school-based health centers (SBHCs), funding streams and technical assistance are needed from various resources. The core funding models for service delivery include federal grants, state grants, local funding, community partnerships, foundations, and patient revenue. Technical assistance opportunities are available through professional organizations, SBHC associations, state health departments, and primary care associations at the national and state levels. This article explores the various federal, state, and local funding sources, and the technical assistance resources and opportunities available to SBHCs and their staff.

Communication and education about triggers and environmental control strategies during pediatric asthma visits.

OBJECTIVE: To determine the extent to which providers, caregivers, and pediatric asthma patients discussed environmental trigger control during primary care visits, and any demographic characteristics associated with having these discussions. METHODS: Children ages 8-16 with persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio-tape recorded. We administered questionnaires to the child's caregiver following the visit. RESULTS: Two hundred and ninety-six patients had useable audio-tape data. Providers typically discussed at least one type of asthma trigger during these visits (86% of visits). The most common discussions were about exercise (70%), the weather/season (42%), and allergies/pollen (35%). Environmental control strategies were discussed less frequently (27% of visits). Providers educated the patient and their caregiver about environmental control strategies during 14% of the visits. CONCLUSION: Although providers frequently discuss some environmental triggers and provide education, there is room for more comprehensive discussions of these issues, which may contribute to decreased asthma exacerbations. PRACTICE IMPLICATIONS: Providers, or alternatively, asthma health educators, should devote more time to discussing environmental asthma triggers and control strategies with pediatric asthma patients and their families, as they are important components of overall asthma control.

Caregiver rating of provider participatory decision-making style and caregiver and child satisfaction with pediatric asthma visits.

OBJECTIVE: The purpose of this study was to examine the relationship between caregiver ratings of provider use of a participatory decision-making style and caregiver and child satisfaction with their pediatric asthma visits. METHODS: Children ages 8 through 16 with persistent asthma and their caregivers were recruited at five pediatric practices. Children were interviewed and caregivers completed questionnaires after their child's medical visits. Generalized estimating equations were used to analyze the data. RESULTS: Three hundred and twenty children were recruited. Caregivers were significantly more satisfied with providers who they perceived as using more of a participatory decision-making style (beta=17.80, p<0.001). Children (beta=-0.10, p<0.05) and caregivers (beta=-0.21, p<0.01) were significantly more satisfied with younger providers. Children were significantly more satisfied with providers who knew them better as a person (beta=2.87, p<0.001). CONCLUSIONS: Caregivers were more satisfied with providers who they perceived as involving them more during treatment decisions made during pediatric asthma visits. PRACTICE IMPLICATIONS: Providers should attempt to use a more participatory decision-making style with families during pediatric asthma visits.

Provider demonstration and assessment of child device technique during pediatric asthma visits.

OBJECTIVE: The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits. PATIENTS AND METHODS: Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants. RESULTS: Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits. CONCLUSIONS: There is a need for providers to demonstrate proper asthma medication and monitoring device techniques to children and to have children demonstrate to proficiency. The 2007 National Heart, Lung, and Blood Institute expert panel report on the diagnosis and management of asthma encourages providers to educate children on these techniques.