Congruence of Perception of Asthma Control Between Parents, Children, and Clinicians

Britain Elise Somple

Abstract


Childhood asthma is a serious public health issue due to high prevalence and costs. It is currently the most common chronic childhood illness, affecting approximately 7 million children ages 0-17 years. Under perception of asthma symptoms is a risk factor for ED visits and hospitalizations in children. It has been estimated that asthma costs the US healthcare system $56 billion annually, inclusive of the direct cost of providing treatment (approx. $1039/child/year) as well as lost productivity costs due to missed school and work and activity limitations. Poor perception of symptoms leads to poor medication adherence, which further exacerbates asthma symptoms. Evidence indicates that perception of pulmonary function and adherence to controller medications is worse in Puerto Rican and African-American children versus Caucasian children. Accurate perception of asthma symptoms and control and medication adherence is key to improving outcomes and reducing costs incurred. Purpose: This secondary analysis examines sociodemographic differences in parent and child perceptions of asthma control and compares these subjective perceptions with clinician ratings. Theory: The Common Sense Model of Illness Representation provides the theoretical framework for investigating outcomes through symptom perception, illness representations, and controller medication adherence. Subjects: Baseline data were collected from 514 Mexican and Puerto Rican caregivers and children ages 5-12 with asthma requiring daily controller medications. Families were recruited from 4 clinics in Phoenix, Arizona and Bronx, New York where there are higher populations of inner-city poor Mexican and Puerto Rican children with asthma. Method: This is a longitudinal study of parental illness representations, controller medication use, and asthma control among a sample of Latino families of children with asthma. Structured interviews with parents, short interviews with children, measures of children’s lung function, and children’s medical records reviews are conducted at enrollment, and 3, 6, 9, and 12 months post-enrollment. Chi-square, t-tests, and linear regression analyses were conducted. Results: There were statistically significant differences between parent’s perception and clinician ratings of children’s asthma control. Thirty-three percent of parents rated their children as well-controlled yet the clinician indicated poor control. This places the child at risk because medications may not be initiated or increased as required. Significantly more children viewed themselves as poorly controlled yet were rated well-controlled by the clinician (46%); they are over-perceiving symptoms which may lead to excess medication use. Predictors of well-controlled asthma were older child age, Mexican, and parent rating of good control. Conclusions: Significant discrepancies exist between parent’s and children’s subjective perception of control and clinician’s objective assessment. Interventions are needed to improve symptom perception and medication adherence resulting in decreased ED visits, hospitalizations, and costs incurred.


Keywords


Asthma; Illness Representation; Asthma Symptom Perception; Spirometry

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