June 15th 2016

Retail clinicians should make a concerted effort to educate the parents of children with asthma about controller medications.

Retail clinicians should make a concerted effort to educate the parents of children with asthma about controller medications.

A new study published inThe Journal of Allergy and Clinical Immunologyrevealed that parents’ reports about how their children are supposed to use inhaled steroids mismatched the providers’ reports for half of the children examined.

The researchers pointed out that inhaled corticosteroids (ICS), leukotriene antagonists (LTRA), and combination ICS and long-acting beta-agonists (ICS/LABAs) not only improve lung function, but also help reduce the number of hospitalizations, emergency department visits, and the use of oral corticosteroids.

Although clinical guidelines recommend that children with asthma take these controller medications, research shows that many pediatric patients don’t use them. One reason may be that providers are underdiagnosing or undertreating asthma, though additional factors may include parent nonadherence or confusion about how the medication is used.

The researchers sought to uncover trends in prescribing patterns for asthma medications, determine how often parent and provider reports mismatched, and find out how parents’ attitudes factored into these mismatches. Surveys were taken by both parents and providers of children with probable persistent asthma (defined as a diagnosis of asthma and the dispensing of at least 1 controller medication) in a Medicaid program and 4 commercial health plans in 2011.

The parents were read a list of brand and generic names of controller medications, and a research assistant asked the parents which medicine their child was taking. Both providers and parents were also asked, “How is the child supposed to use this medicine?”

The study involved 740 children, whose mean age was around 8.6 years. Children with severe asthma weren’t included in the study.

Here were some of the researchers’ main findings:

· In general, the providers didn’t prescribe controller medications for most patients with possible persistent asthma on a daily basis.

· Providers for half of the children said they prescribed controller medications for daily use year-round, while providers for 41% prescribed the medications for daily use only during active asthma months. Meanwhile, 9% only prescribed controller medications forintermittent use for symptom relief.

· 77% of the children were supposed to be taking an ICS, 23% were supposed to be taking LTRA, and 10% an ICS/LABA, according to the providers. According to the parents, 68% were supposed to be taking an ICS, 22% an LTRA, and 10% an ICS/LABA.

· The researchers uncovered a mismatch between the parent and provider in 29% of the children who ideally should have been taking ICS, 10% an LTRA, and 16% an ICS/LABA.

· Less than three-quarters of the parents knew which class of controller medication was prescribed, and less than half knew the administration frequency.

· If the parents felt that the medication wasn’t helping, the child was more likely to be nonadherent.

· Parents were less likely to correctly identify the same controller medication type as the provider if they were Latino or believed the medication wasn’t working.

The study authors stated that this finding was particularly critical because previous research has shown Latino populations have higher morbidity and mortality from asthma compared with white children.

Retail clinicians may be able to identify parents whose children use less medication than the providers intended by asking if they believe the medication is helping their child.

Contemporary ClinicEditorial Board member, Kristen Marjama, DNP, FNP-BC, education and training manager with Walmart Care Clinics in Fort Lauderdale, Florida, also believes retail clinicians are well-placed to provide patient counseling points regarding proper use and administration of their asthma medications.

“Improving provider-patient communication during medical visits could help with caregiver-reported medicine adherence,” the researchers concluded. “…The frequent mismatch in understanding of which controller medications a child should be taking and how often implies that many providers may be unaware of their patients’ lack of adherence and suggests that there is room for improvement in communication about asthma medication regimens.”

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