TY - JOUR
T1 - Concordance among children, caregivers, and clinicians on barriers to controller medication use
AU - Arnold, Carolyn M.
AU - Bixenstine, Paul J.
AU - Cheng, Tina L.
AU - Tschudy, Megan M.
N1 - Funding Information:
This study was funded by pilot grant funding from the Johns Hopkins School of Medicine's Division of General Pediatrics and Adolescent Medicine and by a medical student grant from the Johns Hopkins School of Medicine chapter of the American Medical Women's Association. Funds were used for day-to-day study expenses. Thank you to the families and clinicians who participated in this study for allowing us to learn from their experiences, and to Tatiahna Rivera for her assistance in data collection. The authors report no financial relationships relevant to this article and no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding Information:
This study was funded by pilot grant funding from the Johns Hopkins School of Medicine’s Division of General Pediatrics and Adolescent Medicine and by a medical student grant from the Johns Hopkins School of Medicine chapter of the American Medical Women’s Association. Funds were used for day-to-day study expenses.
Publisher Copyright:
© 2018, © 2018 Taylor & Francis Group, LLC.
PY - 2018/12/2
Y1 - 2018/12/2
N2 - Objective: While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. Methods: We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7–17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. Results: Fifty child–caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a “pain to take” (vs. children) and forgetfulness (vs. caregivers) (all p <.05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. Conclusions: There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child–caregiver disagreements.
AB - Objective: While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. Methods: We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7–17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. Results: Fifty child–caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a “pain to take” (vs. children) and forgetfulness (vs. caregivers) (all p <.05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. Conclusions: There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child–caregiver disagreements.
KW - Medication adherence
KW - community pediatrics
KW - cross-sectional design
KW - family–clinician discordance
KW - mixed methods
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U2 - 10.1080/02770903.2018.1424188
DO - 10.1080/02770903.2018.1424188
M3 - Article
C2 - 29420091
AN - SCOPUS:85041500037
SN - 0277-0903
VL - 55
SP - 1352
EP - 1361
JO - Journal of Asthma
JF - Journal of Asthma
IS - 12
ER -