HOUSTON — Among inner-city children, poor visual recognition of asthma controller medications by patients and their caregivers is linked to worse compliance and disease outcomes, according to new data.
“Optimizing adherence to medication is the key component and challenge for better asthma control. Factors affecting adherence include patients’ medication beliefs, mental health symptoms, provider communication limitations — including implicit biases regarding cultural differences, patients’ limited English proficiency or literacy — and system issues, such as insurance and the cost of medications,” Mansi Kothari, MD, chief resident of pediatrics at the Mount Sinai/Elmhurst Hospital Program, said during a presentation at the American College of Allergy, Asthma and Immunology Annual Meeting.
To examine whether patients’ and caregivers’ ability to visually recognize asthma medications was one of those barriers, Kothari and colleagues conducted a retrospective chart review of 163 children with asthma who were admitted to Children’s Hospital of Michigan in Detroit for status asthmaticus between April 2018 and March 2019. All patients had been prescribed daily inhaled corticosteroid controller therapy before admission.
Results showed that more children who were unable to recognize controller medication or whose caregivers were unable to recognize controller medication, as compared with those who were able to recognize controller medication, had more than three ED visits per year (53.3% vs. 30.7%; P = .004), had three or more systemic steroid bursts for asthma per year (37.3% vs. 19.3%; P = .014) and reported increased daily use of albuterol (25.3% vs. 13.6%; P = .072).
Among inner-city children, poor visual recognition of asthma controller medications by patients and their caregivers is linked to worse compliance and disease outcomes, according to new data.
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The researchers also found that patients with fewer than two allergy clinic follow-up visits per year were more likely to be unable to recognize the controller medication than those with two to four or four or more follow-up visits per year (77.3% vs. 46.6%; P = .001). Similarly, patients and caregivers who went more than 6 months in between prescription refills were more likely to be unable to recognize the controller medication than those who refilled prescriptions every 3 to 6 months or those who refilled prescriptions at least every 3 months (45.1% vs. 21.8%; P = .002).
In a binary logistic regression model, significant predictors of inability to recognize controller medication included having three or more ED visits per year (OR = 3.26; 95% CI, 1.52-6.68) and poor rate of allergy clinic follow-up (OR = 3.42; 95% CI, 1.52-7.71). Poor rate of prescription refill also strongly correlated with inability to recognize controller medication, but the finding was not statistically significant (OR = 2.03; 95% CI, 0.9-4.54), according to Kothari.
“We speculate that we could have better outcomes and maybe more effective adherence with incorporation of a more visually friendly asthma plan in place of the current written standard, especially in the inner-city population,” she said. – by Melissa Foster
Kothari M, et al. A203. Presented at: American College of Allergy, Asthma and Immunology Annual Meeting; Nov. 7-11, 2019; Houston.
Disclosure: Kothari reports no relevant financial disclosures.