Butz Arlene, Sellers M Denise, Land Cassia, Walker Jennifer, Tsoukleris Mona, Bollinger Mary Elizabeth
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Asthma. 2009 Apr;46(3):308-13. doi: 10.1080/02770900902718845.
Lack of discussion regarding actual asthma medication use by physicians with caregivers of children with asthma may result in low caregiver and physician concordance about prescribed asthma medications.
The primary objective was to examine the concordance between primary care providers (PCP) and caregivers regarding child asthma medication use.
Current asthma medications in the home with verification from each child's PCP were obtained for 231 underserved children with persistent asthma. Kappas and chi-square statistics were calculated to measure the strength of the concordance. Caregiver and PCP dyads were categorized as concordant or discordant based on asthma medication use.
For all asthma prescriptions N = 479, two thirds of caregiver-PCP dyads (67.8) were categorized as concordant with at least one asthma medication. Concordance for asthma medications varied by type of medication ranging from 84% agreement for albuterol and 77% agreement for Flovent. In the final regression model predicting caregiver and PCP concordance, the number of PCP visits within the past 6 months and caregiver report of no limitation of child's activity due to asthma were significantly higher in caregivers who were considered concordant with their child's PCP while controlling for child age and frequency of symptom nights and number of ED visits in prior 6 months. In a model predicting the number of PCP visits, the number of ED visits was the only significant variable associated with the number of PCP visits while controlling for caregiver and PCP concordance.
Caregiver and PCP concordance was significantly associated with increased number of PCP visits suggesting that increased exposure to a health care provider may increase agreement between a child's PCP and caregiver regarding prescribed asthma medications. However, there may be other important factors including increased emergency department visits that may also be associated with subsequent pediatric primary care visits for asthma.
医生与哮喘患儿的照顾者之间缺乏关于哮喘药物实际使用情况的讨论，可能导致照顾者与医生在哮喘药物处方方面的一致性较低。
主要目的是研究初级保健提供者（PCP）与照顾者在儿童哮喘药物使用方面的一致性。
获取了231名未得到充分服务的持续性哮喘患儿家中目前正在使用的哮喘药物，并经每位患儿的PCP核实。计算卡帕值和卡方统计量以衡量一致性的强度。根据哮喘药物使用情况，将照顾者与PCP的二元组分为一致或不一致。
对于所有哮喘处方（N = 479），三分之二的照顾者 - PCP二元组（67.8%）被归类为在至少一种哮喘药物使用上一致。哮喘药物的一致性因药物类型而异，沙丁胺醇的一致性为84%，氟替卡松的一致性为77%。在预测照顾者与PCP一致性的最终回归模型中，在控制儿童年龄、症状发作夜晚频率和前6个月急诊就诊次数的情况下，过去6个月内PCP就诊次数以及照顾者报告孩子的活动未因哮喘受到限制，在被认为与孩子的PCP一致的照顾者中显著更高。在一个预测PCP就诊次数的模型中，急诊就诊次数是在控制照顾者与PCP一致性时与PCP就诊次数相关的唯一显著变量。
照顾者与PCP的一致性与PCP就诊次数增加显著相关，这表明增加与医疗保健提供者的接触可能会提高儿童的PCP与照顾者在哮喘药物处方方面的一致性。然而，可能还有其他重要因素，包括急诊就诊次数增加，这也可能与随后因哮喘进行的儿科初级保健就诊有关。
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