ADHERENCE INTERVENTION FOR MINORITY CHILDREN WITH ASTHMA

Johns Hopkins University, Baltimore MD

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Abstract

Low-income, minority children have disproportionately high rates of emergency department (ED) care for asthma compared to other children. Lack of access to asthma primary care and under-treatment of asthma have been implicated as contributing factors to this excess morbidity. Preliminary research by this group suggests that poor adherence with prescribed asthma therapies may also play a significant role. In a pilot study of low-income, minority children with symptomatic asthma we observed average daily adherence with anti-inflammatory therapy ranging from 1 percent to 32 percent of prescribed use. We hypothesize that improved adherence with asthma therapy can significantly reduce emergency room use for asthma care among high-risk children. To test this hypothesis, we will evaluate the effectiveness of an intensive adherence intervention that utilizes electronic medication monitors and medication measurement for monitoring and feedback, compared to a home-based asthma education intervention, and a usual care control group. The Johns Hopkins Pediatric Emergency Department (JHPED) will serve as our recruitment site. Families of asthmatic children ages 2-12 (N=270) with two or more emergency room visits or a hospitalization for asthma care in the past 12 months will be enrolled. Baseline measures will be collected after obtaining consent and prior to randomization. Participants will be randomly assigned to: 1) an Asthma Basic Care Intervention, or 2) an Adherence Monitoring and Feedback Intervention, or 3) a Usual Care Control Group. The duration of each intervention will be three months, with two booster visits at 6 months. Follow-up measures will be collected from families at 6, 12, and 18 months. The primary outcome measure will be medical record documented emergency care for asthma at the JHPED or other emergency or urgent care facilities over the eighteen-month follow-up period. Secondary outcomes include adherence with asthma therapy based on Medicaid pharmacy claims for asthma medications, other asthma health care (urgent and primary), self-reported medication adherence, barriers to health care, school absences, restricted activity, nighttime symptoms, asthma medications, self and family asthma management, asthma management self-efficacy, functional status, and quality of life.