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American Academy of Pediatrics
Article

Patient Factors Used by Pediatricians to Assign Asthma Treatment

Sande O. Okelo, Cecilia M. Patino, Kristin A. Riekert, Barry Merriman, Andrew Bilderback, Nadia N. Hansel, Kathy Thompson, Jennifer Thompson, Ruth Quartey, Cynthia S. Rand and Gregory B. Diette
Pediatrics July 2008, 122 (1) e195-e201; DOI: https://doi.org/10.1542/peds.2007-2271
Sande O. Okelo
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Cecilia M. Patino
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Kristin A. Riekert
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Barry Merriman
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Andrew Bilderback
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Nadia N. Hansel
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Kathy Thompson
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Jennifer Thompson
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Ruth Quartey
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Cynthia S. Rand
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Gregory B. Diette
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Abstract

OBJECTIVE. Although asthma is often inappropriately treated in children, little is known about what information pediatricians use to adjust asthma therapy. The purpose of this work was to assess the importance of various dimensions of patient asthma status as the basis of pediatrician treatment decisions.

PATIENTS AND METHODS. We conducted a cross-sectional, random-sample survey, between November 2005 and May 2006, of 500 members of the American Academy of Pediatrics using standardized case vignettes. Vignettes varied in regard to (1) acute health care use (hospitalized 6 months ago), (2) bother (parent bothered by the child's asthma status), (3) control (frequency of symptoms and albuterol use), (4) direction (qualitative change in symptoms), and (5) wheezing during physical examination. Our primary outcome was the proportion of pediatricians who would adjust treatment in the presence or absence of these 5 factors.

RESULTS. Physicians used multiple dimensions of asthma status other than symptoms to determine treatment. Pediatricians were significantly more likely to increase treatment for a recently hospitalized patient (45% vs 18%), a bothered parent (67% vs 18%), poorly controlled symptoms (4–5 times per week; 100% vs 18%), or if there was wheezing on examination (45% vs 18%) compared with patients who only had well-controlled symptoms. Pediatricians were significantly less likely to decrease treatment for a child with well-controlled symptoms and recent hospitalization (28%), parents who reported being bothered (43%), or a child whose symptoms had worsened since the last doctor visit (10%) compared with children with well-controlled symptoms alone.

CONCLUSIONS. Pediatricians treat asthma on the basis of multiple dimensions of asthma status, including hospitalization, bother, symptom frequency, direction, and wheezing but use these factors differently to increase and decrease treatment. Tools that systematically assess multiple dimensions of asthma may be useful to help further improve pediatric asthma care.

  • asthma
  • pediatrics
  • treatment
  • decision-making
  • survey
  • Accepted January 17, 2008.
  • Copyright © 2008 by the American Academy of Pediatrics

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Pediatrics
Vol. 122, Issue 1
July 2008
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Patient Factors Used by Pediatricians to Assign Asthma Treatment
Sande O. Okelo, Cecilia M. Patino, Kristin A. Riekert, Barry Merriman, Andrew Bilderback, Nadia N. Hansel, Kathy Thompson, Jennifer Thompson, Ruth Quartey, Cynthia S. Rand, Gregory B. Diette
Pediatrics Jul 2008, 122 (1) e195-e201; DOI: 10.1542/peds.2007-2271

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Patient Factors Used by Pediatricians to Assign Asthma Treatment
Sande O. Okelo, Cecilia M. Patino, Kristin A. Riekert, Barry Merriman, Andrew Bilderback, Nadia N. Hansel, Kathy Thompson, Jennifer Thompson, Ruth Quartey, Cynthia S. Rand, Gregory B. Diette
Pediatrics Jul 2008, 122 (1) e195-e201; DOI: 10.1542/peds.2007-2271
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