SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

5/20/03

Communications efficacy as a factor in asthma compliance

Summary
Compliance with childhood asthma management plans remains a major problem, particularly in inner-city patient populations. Rickert et al investigated possible communication problems as causal factors in poor compliance. They surveyed the caregivers and treating physicians for 318 inner-city children with physician-diagnosed asthma (moderate to severe in 64% of cases). They found that the physicians and caregivers disagreed whether a controller medication had been prescribed in 22% of the children. Disagreement was seen more in cases where the caregivers tended to have poor attitudes about asthma management; often did not understand the need for daily controller medications and were more likely to be concerned about possible medication side effects. The authors stressed that physicians must learn to communicate more effectively with inner-city caregivers with resultant improved health outcomes and patient satisfaction.

Reference
Pediatrics 2003;111:214-220

Editor's Comments
These findings are sobering but not too surprising. One would expect such mis-communications between physicians and the family caregivers of asthmatic children to be reduced if written management plans are given in every case. However, most controlled studies have shown no significantly better health outcomes in those given written asthma management plans versus those instructed verbally in the traditional sense.

This lack of greater benefit from use of written management plans may be explained that many of such widely promulgated written asthma management plans are written at a literacy level well above the reported median 5th grade reading level of the average US adult. This factor may be particularly prevalent in the case of inner-city populations. In my own experience, repeated, careful explanations by the health care personnel to the caregivers is very important, including discussions to allay unfounded concerns about the potential for adverse effects of inhaled steroids. Such explanation may often be given more effectively by a trained allied health support staff member than by the very busy physician who may have less patience to give the instructions slowly and repeatedly.

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