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Providers Underestimate Symptom Severity Among Urban Children With Asthma
Jill S. Halterman, MD, MPH;
H. Lorrie Yoos, PhD;
Jeffrey M. Kaczorowski, MD;
Kenneth McConnochie, MD, MPH;
Robert J. Holzhauer, MD;
Kelly M. Conn, BS;
Sherri Lauver, MS;
Peter G. Szilagyi, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:141-146.
Background Guidelines recommend that children with mild persistent to severe persistent
asthma receive maintenance anti-inflammatory medications. However, providers
may not be aware of the severity of their patients' symptoms. The underestimation
of severity may contribute to poor adherence to asthma care guidelines.
Objectives To describe the use of preventive medications among a group of urban
children with mild persistent to severe persistent asthma and to evaluate
the degree to which their health care providers are aware of their asthma
severity.
Design Children (ages 4-6 years) from urban schools in Rochester, NY, were
eligible if their parents reported mild persistent to severe persistent asthma
symptoms. Each child's health care provider was asked to assess the child's
asthma severity and use of medications based both on their knowledge of the
child and review of the medical record. Parent and provider assessments were
compared. Bivariate and regression analyses were used to identify factors
associated with concordant classifications of asthma severity.
Results Ninety children with parent-defined mild persistent to severe persistent
asthma participated (64% boys, 67% black, 73% receiving Medicaid). Only 40%
of the children were described accurately by their providers as having mild
persistent to severe persistent asthma, and only 50% of the total had been
prescribed maintenance medications. Thirty-six percent of families reported
that their child used maintenance medications daily. In contrast, most of
the children who were classified by their provider as having mild persistent
to severe persistent asthma were prescribed a maintenance medication (83%),
and 58% used them daily. Sociodemographic characteristics and asthma severity
were not associated with provider accuracy.
Conclusions Most children in this study were not accurately classified by their
providers as having mild persistent to severe persistent asthma and had not
been prescribed maintenance medications. When providers were aware of their
patient's asthma symptoms, most of the children were prescribed maintenance
medications. Attempts to improve adherence to asthma guidelines should take
into consideration provider underestimations of asthma severity.
From the Department of Pediatrics, the University of Rochester School
of Medicine and Dentistry and Strong Children's Hospital (Drs Halterman, Kaczorowski,
McConnochie, Holzhauer, and Szilagyi, and Mss Conn and Lauver), and the School
of Nursing (Dr Yoos), University of Rochester, Rochester, NY.
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