Care setting affects likelihood that children with persistent asthma will receive inhaled steroids
Key components of quality care for children with persistent asthma include prescribing inhaled steroids, vaccinating the child against influenza, and discussing an asthma action plan with the child's parent. These children are less likely to receive inhaled steroids if they receive care in community health centers or hospital clinics than in multispecialty group practices, according to a new study.
The practice setting mediated initially observed disparities in inhaled steroid use by Latino children and those whose provider predominantly served minority patients. For example, without adjusting for other factors affecting receipt of inhaled steroids, Latino children and those whose health care providers predominantly served minority patients were more likely to have never received inhaled steroids. However, after adjusting for patient, provider, and practice characteristics there were no significant differences in receipt of inhaled steroids for children with minority-serving providers or for Latino versus white children. In contrast, children receiving care in community health centers or hospital clinics were more than four times as likely to have never received inhaled steroids than children seen in multispecialty practices. These differences were not seen for children's receipt of influenza vaccinations or asthma action plans.
Based on the study's findings, efforts to increase the use of inhaled steroids for children with persistent asthma should focus on settings such as community health centers and hospital clinics, conclude the researchers. Their study included 563 children with persistent asthma, aged 2 to 12 years, who were part of a large, multispecialty group practice in metropolitan Boston or Neighborhood Health Plan (a Massachusetts health plan predominantly for Medicaid recipients). Parents of eligible children and the children's primary care providers were surveyed. The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00063).
More details are in "Asthma care quality for children with minority-serving providers," by Alison A. Galbraith, M.D., M.P.H., Lauren A. Smith, M.D., M.P.H., Barbara Bokhour, Ph.D., and others in the January 2010 Archives of Pediatric and Adolescent Medicine 164(1), pp. 38-43.
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