Objective. To determine the consistency of care for pediatric asthma with the National Asthma Education and Prevention Program guidelines.
Study Population. The study included 318 children 5 to 17 years old with asthma.
Methods. A cross-sectional survey at 2 managed care organizations in the United States was conducted in 1997–1998. The participants were actually the parents of the 318 children with asthma. The outcome measures were an evaluation of the care provided in 4 domains: 1) periodic physiologic assessment, 2) appropriate use of medications, 3) patient education, and 4) control of factors contributing to asthma severity.
Results. A total of 533 patients were eligible for the study and 318 (60%) participated. A total of 59% were male, 76% were white, and 60% were 5 to 10 years of age. Deficiencies in care were identified in all domains, including 45% of children with moderate and severe asthma on no daily long-term controllers, 49% having written instructions for managing asthma episodes, 44% having instructions for the appropriate use of medication before exposures, and 56% having been evaluated by allergy testing, and 54% having been evaluated by pulmonary function tests.
Conclusion. The care of children with asthma is deficient in many areas, particularly including the use of controller medications and asthma education.
Reviewer’s Comments. This study clearly indicates the need for a comprehensive approach to asthma management in managed care settings. These results, however, are almost certainly applicable to most primary care settings, where time constraints make it difficult for even the best-educated practitioner to implement all of the necessary components of asthma care. For most patients with moderate and severe asthma, care will be most effectively delivered in a collaborative effort between the primary caretaker and an asthma consultant.
- Copyright © 2002 by the American Academy of Pediatrics