Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e900-e905 (doi:10.1542/peds.2007-1559)
Selective Provision of Asthma Self-Management Tools to Families
Michael D. Cabana, MD, MPHa,b,c, D. Curt Chaffin, MDd, Leah G. Jarlsberga, Shannon M. Thyne, MDa and Noreen M. Clark, PhDe
a Department of Pediatrics
b Department of Epidemiology and Biostatistics
c Institute for Health Policy Studies, University of California, San Francisco, California
d Division of Allergy, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
e Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan
OBJECTIVE. Providing asthma education in a primary care setting can be challenging because of time and resource constraints. The purpose of this work was to determine factors associated with the provision of different asthma self-management tools.
METHODS. We conducted a cross-sectional survey with 896 parents of children with asthma (age 2–12 years). We collected information regarding demographics and asthma care, including parent receipt of an asthma action plan, a symptom diary, and asthma information materials; whether an asthma management plan was sent to the child’s school; and whether the physician reviewed written instructions on use of a metered-dose inhaler. We used multivariate logistic regression methods to determine factors associated with receipt of different asthma self-management tools controlling for demographic factors.
RESULTS. For families where parents only completed high school, there was greater likelihood of receipt of an asthma action plan and physician review of written instructions about how to use an inhaler. For families with a household income less than twice the poverty line, there was greater likelihood of receipt of an asthma action plan, the physician sending a letter to the child’s school regarding the child’s asthma, and receipt of an asthma symptom diary.
CONCLUSIONS. In our sample, primary care pediatricians do not routinely provide asthma education in accordance with National Heart, Lung, and Blood Institute asthma guidelines and “triage” which families receive additional asthma education. We believe that the use of targeted asthma education is a symptom of the limited time and competing demands during a typical visit. As a result, those involved in quality improvement need to help physicians become more efficient and effective at providing asthma education within such time constraints or develop alternative systems of providing asthma education.