TY - JOUR
T1 - Family Caregiver Marginalization is Associated With Decreased Primary and Subspecialty Asthma Care in Head Start Children
AU - Sadreameli, S. Christy
AU - Riekert, Kristin A.
AU - Matsui, Elizabeth C.
AU - Rand, Cynthia S.
AU - Eakin, Michelle N.
N1 - Funding Information:
This trial is registered at ClinicalTrials.gov : NCT01519453 . Financial disclosure: Funding source: NIH HL 5R18HL107223 . Ethical approval: The Johns Hopkins School of Medicine institutional review board approved the study. Previous presentations: Preliminary data were presented in abstract form at the May 2017 American Thoracic Society Meeting in Washington, DC.
Funding Information:
Financial disclosure: Funding source: NIH HL 5R18HL107223.
Publisher Copyright:
© 2018 Academic Pediatric Association
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Urban minority children are at risk for poor asthma outcomes and might not receive appropriate primary or subspecialty care. We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma. Methods: The Barriers to Care Questionnaire (BCQ) is used to measure expectations, knowledge, marginalization, pragmatics, and skills. We assessed asthma control using the Test for Respiratory and Asthma Control in Kids and these outcomes: PCP visits for asthma in the past 6 months, subspecialty care (allergist or pulmonologist) in the past 2 years, and ED visits in the past 3 months. Results: Three hundred ninety-five caregivers (96% African-American, 82% low-income, 96% Medicaid) completed the BCQ. Sixty percent (n = 236) of children had uncontrolled asthma, 86% had seen a PCP, 23% had seen a subspecialist, and 29% had an ED visit. Barriers related to marginalization were associated with decreased likelihood of PCP (odds ratio [OR], 0.95; P =.014) and subspecialty visits (OR, 0.92; P =.019). Overall BCQ score was associated with decreased likelihood of subspecialty care (OR, 0.98; P =.027). Barriers related to expectations, knowledge, pragmatics, and skills were not associated with any of the care outcomes. Conclusions: Among low-income, predominantly African-American preschool children with asthma, primary and subspecialty care were less likely if caregivers reported past negative experiences with the health care system (marginalization). Clinicians who serve at-risk populations should be sensitive to families’ past experiences and should consider designing interventions to target the most commonly reported barriers.
AB - Background: Urban minority children are at risk for poor asthma outcomes and might not receive appropriate primary or subspecialty care. We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma. Methods: The Barriers to Care Questionnaire (BCQ) is used to measure expectations, knowledge, marginalization, pragmatics, and skills. We assessed asthma control using the Test for Respiratory and Asthma Control in Kids and these outcomes: PCP visits for asthma in the past 6 months, subspecialty care (allergist or pulmonologist) in the past 2 years, and ED visits in the past 3 months. Results: Three hundred ninety-five caregivers (96% African-American, 82% low-income, 96% Medicaid) completed the BCQ. Sixty percent (n = 236) of children had uncontrolled asthma, 86% had seen a PCP, 23% had seen a subspecialist, and 29% had an ED visit. Barriers related to marginalization were associated with decreased likelihood of PCP (odds ratio [OR], 0.95; P =.014) and subspecialty visits (OR, 0.92; P =.019). Overall BCQ score was associated with decreased likelihood of subspecialty care (OR, 0.98; P =.027). Barriers related to expectations, knowledge, pragmatics, and skills were not associated with any of the care outcomes. Conclusions: Among low-income, predominantly African-American preschool children with asthma, primary and subspecialty care were less likely if caregivers reported past negative experiences with the health care system (marginalization). Clinicians who serve at-risk populations should be sensitive to families’ past experiences and should consider designing interventions to target the most commonly reported barriers.
KW - Head Start
KW - asthma
KW - barriers to care
KW - marginalization
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U2 - 10.1016/j.acap.2018.04.135
DO - 10.1016/j.acap.2018.04.135
M3 - Article
C2 - 29730244
AN - SCOPUS:85048284103
SN - 1876-2859
VL - 18
SP - 905
EP - 911
JO - Academic pediatrics
JF - Academic pediatrics
IS - 8
ER -