September 3, 2012
Asthmatic children do a better job of taking their meds if they and their parents are included in the decision-making when the doctor and child are discussing medications, according to a new study from the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill.
“Work we’ve done previously showed that physicians rarely ask for input from the child or the parents when creating an asthma-treatment plan,” says Betsy Sleath, PhD, lead author on the study. “In our study, less than 10 percent of the health-care providers did. That’s a missed opportunity.”
The National Asthma Education and Prevention Program encourages physicians to discuss medications with patients at every follow-up asthma visit and also emphasizes the importance of jointly determining the goals of treatment with the patient’s family. Sleath’s team wanted to know whether doing so would improve how well children adhere to their treatment regimen.“It’s about shared decision-making that includes the patient, the physician, and the parent or caregiver,” Sleath says. “We have seen evidence that it helps adult asthma patients, but no one had examined whether it would help children.”
The researchers recruited 296 children ages eight to sixteen with persistent asthma along with their caregivers at five pediatric practices in nonurban areas of North Carolina. Two hundred fifty-nine children were interviewed one month after their medical visits, and both children and caregivers reported the child’s control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence one month later. The findings were published online September 3 in the journal Pediatrics.
There was a strong correlation between shared decision making at the doctor’s office and better adherence, Sleath says. When the physician included the caregiver in creating the treatment plan, the caregivers reported that their children took their medicine as directed 80 percent of the time, compared to only 72 percent in cases where the physician did not include caregiver input.
“Getting caregivers involved in treatment decisions can help their children use their asthma medications more effectively and consistently,” Sleath says.
Sleath is the George H. Cocolas Distinguished Professor and chair of the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy
Sleath’s coauthors on the study from the School are research assistant professor Delesha M. Carpenter, PhD, MSPH; graduate student Catherine Slota; and associate professor Dennis Williams, PharmD. Additional coauthors are Gail Tudor, PhD, of Husson University; Karin Yeatts, PhD, of the University of North Carolina at Chapel Hill; Stephanie Davis, MD, of the Riley Hospital for Children in Indianapolis; and Guadalupe X. Ayala, PhD, MPH, of San Diego State University.
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