TABLE 5

Barriers to the Adherence to Pediatric Asthma Management and Practice

ED and primary care physicians
    Educational
        Failure to make the diagnosis of asthma
        Limited knowledge and understanding of guidelines because of lack of familiarity, lack of agreement, and insufficient time to review guidelines
        Lack of or incorrect asthma-severity classification leading to inappropriate treatment regimen (eg, not initiating or continuing preventive controller-medication use)
        Failure to provide a written asthma action plan
        Failure to initiate controller-medication therapy for patients with persistent asthma
Patient, parents, and family
    Behavioral
        Failure to seek primary care or identify with primary care physician
        Non-adherence to appropriate controller-medication use and asthma action plan
        Reliance on ED for comprehensive asthma care
            Reasons include minimal or no cost, faster service, and continuous availability (24 h/d)
        Distractions caused by competing priorities for parents including, but not limited to, employment, social engagements, marital stress/divorce/hostility, psychopathology, and substance abuse
        Embarrassment by the child with asthma
    Educational
        Limited knowledge and understanding of asthma and therapeutic skills (use of metered-does inhaler, dry-powder inhaler, nebulizer) and misinformation
        Misunderstanding of instructions for appropriate controller-medication use
        Fear of adverse effects from steroid
Environment dynamic
    Cultural barriers between patient, families, and health care providers impeding optimal management
    Cultural, religious, or faith-based preconceptions/misconceptions of the disease
    Language barriers between patients/families and health care providers impeding optimal management
    Multiple caregivers with poor understanding of preventative or acute asthma treatment
    Single parent with difficulty managing child with persistent asthma on a daily basis
    Nonavailability of 24-h primary care services, poor access to care, lack of medical home and community health care professionals
    School prohibitions of asthma medications because of lack of education