- Email: [email protected]
Awareness of Asthma Control and Asthma Risks: Results of the GAP II Survey of Patients and Primary Care Physicians
160
Awareness of Asthma Control and Asthma Risks: Results of the GAP II Survey of Patients and Primary Care Physicians R. A. Panettieri1, S. L. Spector2, M. L. Mintz3; 1University of Pennsylvania, Philadelphia, PA, 2California Allergy & Asthma Medical Group, Los Angeles, CA, 3George Washington University School of Medicine, Washington, DC. RATIONALE: Patients’ (pts) and physicians’ knowledge of asthma risks and control likely affect long-term outcomes. The General Awareness and Perceptions II (GAP II) Survey sought to assess patient and physician awareness of asthma control. METHODS: A telephone survey was conducted among 1001 pts 18 years on asthma medication the previous year and 300 primary care physicians (PCPs) treating 3 pts weekly. Sampling quotas and data weighting were used to ensure pts were representative of the US population (margin of error 63.1%). RESULTS: The majority of pts (66%) considered asthma a serious condition. Morning was rated as often as nighttime (23% each) as the most problematic time for symptoms. 69% of pts believed that rescue medication could be used daily. Although >90% of pts and PCPs indicated that controller medications (CMs) are most effective when taken every day, 42% of pts and 22% of PCPs stated that CMs could be taken less regularly when symptoms decrease; 25% of pts and 14% of PCPs would stop CMs when asymptomatic. Of the 21% of pts who discontinued CMs, 71% did so due to symptom abatement. Many asymptomatic pts did not feel at risk from asthma and 87% of PCPs think that pts stop taking CMs without their advice. CONCLUSIONS: Despite indicating knowledge of appropriate use of CMs, a large percentage of pts decrease/stop use of CMs with improved symptoms, are likely to use daily rescue medication, and fail to recognize asthma risks while asymptomatic. Nearly a quarter of PCPs would decrease CMs in asymptomatic pts.
161
Scheduled Visits to a Pediatric Clinic as One of the Adherence Factors Influencing Asthma Control K. Nakatani1,2, A. Manki1, M. Narita1, A. Miyazaki1, S. Yoshida3, K. Satsuka1, K. Horimukai1, T. Suda1, I. Nomura1, M. Futamura4, H. Watanabe5, Y. Morisawa6, I. Masuko7, A. Akasawa1, Y. Ohya1; 1National Center for Child Health and Development, Tokyo, Japan, 2Soka Municipal Hospital, Saitama, Japan, 3Graduate School of Education, University of Tokyo, Tokyo, Japan, 4Aichi Children’s Health and Medical Center, Aichi, Japan, 5 National Hospital Organization Kanagawa Hospital, Kanagawa, Japan, 6 Kera Pediatric Clinic, Kouchi, Japan, 7Gunma Prefectural College of Health Sciences, Gunma, Japan. RATIONALE: To keep stable conditions in asthmatic children, the adherences of patients and their caregivers are very important. The aim of this study is to investigate the adherence factors associated with a patient’s scheduled visits to a pediatric clinic. METHODS: One thousand seven hundred and twenty caregivers (their children’s age: 0yo to 18yo) filled the questionnaire sheets comprising 25 items that were generated from a qualitative research precedent to this survey to indentify adherence factors influencing patients’ scheduled visits to clinics. RESULTS: Through the psychometric process including factor analysis, three factors such as doctor-patient relationship, self efficacy and perceived burden of the treatment were identified to be associated with the adherence of patients’ scheduled visits to clinics. The patients who did not adhere to scheduled visits to their doctors showed lower scores in the factor of doctor-patient relationship and that of the self-efficacy, and higher scores in the factor of the perceived burden than the patients who adhered to scheduled visits to their doctors. Especially, the patients with poor adherence to scheduled visit to their doctors in spite of having asthma attacks for the recent 3 months showed lower scores of the self-efficacy. CONCLUSIONS: To keep stable conditions in asthma control of children by their scheduled visits to clinics, it is important for doctors to establish a good relationship with them, to reduce their perceived burden of the treatment and to improve their self-efficacies.
162
Factors Influencing The Adherence Of Asthmatic Children And Caregivers To Corticosteroid Inhalation Therapy K. Satsuka1, Y. Saran2, A. Miyazaki1, A. Manki1, K. Nakatani3, K. Horimukai1, T. Suda1, I. Nomura1, M. Narita1, M. Futamura4, H. Watanabe5, Y. Morisawa6, I. Masuko7, A. Akasawa1, Y. Ohya1; 1National Center for Child Health and Development, Tokyo, Japan, 2Graduate School of Education, University of Tokyo, Tokyo, Japan, 3Soka Municipal Hospital, Tokyo, Japan, 4Aichi Children’s Health and Medical Center, Aichi, Japan, 5 National Hospital Organization Kanagawa Hospital, Tokyo, Japan, 6 Kera Pediatric Clinic, kochi, Japan, 7Gunma Prefectural College of Health Sciences, gunma, Japan. RATIONALE: For the symptom management of pediatric asthma, it is essential to enhance children’s and caregivers’ adherence. Based on the transtheoretical model, this study explored factors that influence their adherence to corticosteroid inhalation therapy. METHODS: Participants were 884 children with asthma and 1720 caregivers in Japan. Questionnaire on adherence stage and relevant factors created originally was conducted. RESULTS: As for children’s adherence, factor analysis identified four domains; ‘‘self-efficacy’’, ‘‘support from family’’, ‘‘perceived burden’’, and ‘‘indication by family’’. By means of one-way ANOVA, significant differences were found among adherence stages of the patients in the scores for ‘‘self-efficacy’’ (F (3,349) 5 23.70, p < .01), ‘‘perceived burden’’ (F(3,352) 5 2.93, p < .05), and ‘‘indication by family’’ (F(3,347)5.52, p < .01). The scores for ‘‘self-efficacy’’ and ‘‘indication by family’’ were higher in asthmatic children with good adherence. As for caregivers’ adherence, five factors; ‘‘understanding of therapy’’, ‘‘priority’’, ‘‘perceived burden’’, ‘‘doctor’s information’’, and ‘‘anxiety’’ were identified. Significant differences were found among adherence stages of the caregivers in the scores for ‘‘understanding of therapy’’ (F(3,706) 5 50.61, p < .01), ‘‘priority’’ (F(3,696) 5 1.36, p < .01), ‘‘perceived burden’’ (F(3,719)8.47, p < .01), and ‘‘doctor’s information’’ (F(3,701) 5 46.69, p < .01). The scores for ‘‘understanding of therapy’’, ‘‘priority’’, and ‘‘doctor’s information’’ were higher in caregivers with good adherence. CONCLUSIONS: To improve the adherence of asthmatic children to corticosteroid inhalation therapy, it would be useful for doctors to enhance their self-efficacy, reduce their perceived burden, and ask their caregivers to encourage them. To improve the adherence of caregivers, doctors need to give enough information, promote their understanding and priority of the therapy, and reduce their perceived burden.
163
Immunotherapy Adherence In A Midwest Private Practice M. E. Bubak, M. Hamre, E. Bubak; Dakota Allergy & Asthma, Sioux Falls, SD. RATIONALE: Evaluate adherence to the minimal recommended time period for subcutaneous immunotherapy. METHODS: Our Immunotherapy (IT) adherence results were reviewed for all patients accepting our recommendation to start IT in our office during years 2001 thru 2004. RESULTS: Six hundred three patients decided to proceed with the recommended IT for Allergic Rhinitis, Asthma, 1/or Hymenoptera Anaphylaxis. 333 were female, 270 male, 602 had AR, 257 Asthma, 4 HA. Ages ranged from 4 to 79, averaging 25. We found 264 completed three full years (44%), 361 (60%) two years, 432 (72%) one year. 123 males completed 3 years (46%), 141 females (43%). No differences were seen between IT at our office vs. at local physician’s. 20 to 29 year olds had the lowest adherence at 29%. Reasons found for quitting included completed IT, never started, reactions, improved, high co-pays, relocation, and no explanation. CONCLUSIONS: Immunotherapy is a long-term effective therapy for allergic disorders that can be disrupted by many factors. Methods to prevent non-adherence such as optimal start age, insurance coverage, schedules, and less reactive IT will lead to more patients succeeding with their IT program.
SATURDAY
Abstracts S45
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
Awareness of Asthma Control and Asthma Risks: Results of the GAP II Survey of Patients and Primary Care Physicians R. A. Panettieri1, S. L. Spector2, M. L. Mintz3; 1University of Pennsylvania, Philadelphia, PA, 2California Allergy & Asthma Medical Group, Los Angeles, CA, 3George Washington University School of Medicine, Washington, DC. RATIONALE: Patients’ (pts) and physicians’ knowledge of asthma risks and control likely affect long-term outcomes. The General Awareness and Perceptions II (GAP II) Survey sought to assess patient and physician awareness of asthma control. METHODS: A telephone survey was conducted among 1001 pts 18 years on asthma medication the previous year and 300 primary care physicians (PCPs) treating 3 pts weekly. Sampling quotas and data weighting were used to ensure pts were representative of the US population (margin of error 63.1%). RESULTS: The majority of pts (66%) considered asthma a serious condition. Morning was rated as often as nighttime (23% each) as the most problematic time for symptoms. 69% of pts believed that rescue medication could be used daily. Although >90% of pts and PCPs indicated that controller medications (CMs) are most effective when taken every day, 42% of pts and 22% of PCPs stated that CMs could be taken less regularly when symptoms decrease; 25% of pts and 14% of PCPs would stop CMs when asymptomatic. Of the 21% of pts who discontinued CMs, 71% did so due to symptom abatement. Many asymptomatic pts did not feel at risk from asthma and 87% of PCPs think that pts stop taking CMs without their advice. CONCLUSIONS: Despite indicating knowledge of appropriate use of CMs, a large percentage of pts decrease/stop use of CMs with improved symptoms, are likely to use daily rescue medication, and fail to recognize asthma risks while asymptomatic. Nearly a quarter of PCPs would decrease CMs in asymptomatic pts.
161
Scheduled Visits to a Pediatric Clinic as One of the Adherence Factors Influencing Asthma Control K. Nakatani1,2, A. Manki1, M. Narita1, A. Miyazaki1, S. Yoshida3, K. Satsuka1, K. Horimukai1, T. Suda1, I. Nomura1, M. Futamura4, H. Watanabe5, Y. Morisawa6, I. Masuko7, A. Akasawa1, Y. Ohya1; 1National Center for Child Health and Development, Tokyo, Japan, 2Soka Municipal Hospital, Saitama, Japan, 3Graduate School of Education, University of Tokyo, Tokyo, Japan, 4Aichi Children’s Health and Medical Center, Aichi, Japan, 5 National Hospital Organization Kanagawa Hospital, Kanagawa, Japan, 6 Kera Pediatric Clinic, Kouchi, Japan, 7Gunma Prefectural College of Health Sciences, Gunma, Japan. RATIONALE: To keep stable conditions in asthmatic children, the adherences of patients and their caregivers are very important. The aim of this study is to investigate the adherence factors associated with a patient’s scheduled visits to a pediatric clinic. METHODS: One thousand seven hundred and twenty caregivers (their children’s age: 0yo to 18yo) filled the questionnaire sheets comprising 25 items that were generated from a qualitative research precedent to this survey to indentify adherence factors influencing patients’ scheduled visits to clinics. RESULTS: Through the psychometric process including factor analysis, three factors such as doctor-patient relationship, self efficacy and perceived burden of the treatment were identified to be associated with the adherence of patients’ scheduled visits to clinics. The patients who did not adhere to scheduled visits to their doctors showed lower scores in the factor of doctor-patient relationship and that of the self-efficacy, and higher scores in the factor of the perceived burden than the patients who adhered to scheduled visits to their doctors. Especially, the patients with poor adherence to scheduled visit to their doctors in spite of having asthma attacks for the recent 3 months showed lower scores of the self-efficacy. CONCLUSIONS: To keep stable conditions in asthma control of children by their scheduled visits to clinics, it is important for doctors to establish a good relationship with them, to reduce their perceived burden of the treatment and to improve their self-efficacies.
162
Factors Influencing The Adherence Of Asthmatic Children And Caregivers To Corticosteroid Inhalation Therapy K. Satsuka1, Y. Saran2, A. Miyazaki1, A. Manki1, K. Nakatani3, K. Horimukai1, T. Suda1, I. Nomura1, M. Narita1, M. Futamura4, H. Watanabe5, Y. Morisawa6, I. Masuko7, A. Akasawa1, Y. Ohya1; 1National Center for Child Health and Development, Tokyo, Japan, 2Graduate School of Education, University of Tokyo, Tokyo, Japan, 3Soka Municipal Hospital, Tokyo, Japan, 4Aichi Children’s Health and Medical Center, Aichi, Japan, 5 National Hospital Organization Kanagawa Hospital, Tokyo, Japan, 6 Kera Pediatric Clinic, kochi, Japan, 7Gunma Prefectural College of Health Sciences, gunma, Japan. RATIONALE: For the symptom management of pediatric asthma, it is essential to enhance children’s and caregivers’ adherence. Based on the transtheoretical model, this study explored factors that influence their adherence to corticosteroid inhalation therapy. METHODS: Participants were 884 children with asthma and 1720 caregivers in Japan. Questionnaire on adherence stage and relevant factors created originally was conducted. RESULTS: As for children’s adherence, factor analysis identified four domains; ‘‘self-efficacy’’, ‘‘support from family’’, ‘‘perceived burden’’, and ‘‘indication by family’’. By means of one-way ANOVA, significant differences were found among adherence stages of the patients in the scores for ‘‘self-efficacy’’ (F (3,349) 5 23.70, p < .01), ‘‘perceived burden’’ (F(3,352) 5 2.93, p < .05), and ‘‘indication by family’’ (F(3,347)5.52, p < .01). The scores for ‘‘self-efficacy’’ and ‘‘indication by family’’ were higher in asthmatic children with good adherence. As for caregivers’ adherence, five factors; ‘‘understanding of therapy’’, ‘‘priority’’, ‘‘perceived burden’’, ‘‘doctor’s information’’, and ‘‘anxiety’’ were identified. Significant differences were found among adherence stages of the caregivers in the scores for ‘‘understanding of therapy’’ (F(3,706) 5 50.61, p < .01), ‘‘priority’’ (F(3,696) 5 1.36, p < .01), ‘‘perceived burden’’ (F(3,719)8.47, p < .01), and ‘‘doctor’s information’’ (F(3,701) 5 46.69, p < .01). The scores for ‘‘understanding of therapy’’, ‘‘priority’’, and ‘‘doctor’s information’’ were higher in caregivers with good adherence. CONCLUSIONS: To improve the adherence of asthmatic children to corticosteroid inhalation therapy, it would be useful for doctors to enhance their self-efficacy, reduce their perceived burden, and ask their caregivers to encourage them. To improve the adherence of caregivers, doctors need to give enough information, promote their understanding and priority of the therapy, and reduce their perceived burden.
163
Immunotherapy Adherence In A Midwest Private Practice M. E. Bubak, M. Hamre, E. Bubak; Dakota Allergy & Asthma, Sioux Falls, SD. RATIONALE: Evaluate adherence to the minimal recommended time period for subcutaneous immunotherapy. METHODS: Our Immunotherapy (IT) adherence results were reviewed for all patients accepting our recommendation to start IT in our office during years 2001 thru 2004. RESULTS: Six hundred three patients decided to proceed with the recommended IT for Allergic Rhinitis, Asthma, 1/or Hymenoptera Anaphylaxis. 333 were female, 270 male, 602 had AR, 257 Asthma, 4 HA. Ages ranged from 4 to 79, averaging 25. We found 264 completed three full years (44%), 361 (60%) two years, 432 (72%) one year. 123 males completed 3 years (46%), 141 females (43%). No differences were seen between IT at our office vs. at local physician’s. 20 to 29 year olds had the lowest adherence at 29%. Reasons found for quitting included completed IT, never started, reactions, improved, high co-pays, relocation, and no explanation. CONCLUSIONS: Immunotherapy is a long-term effective therapy for allergic disorders that can be disrupted by many factors. Methods to prevent non-adherence such as optimal start age, insurance coverage, schedules, and less reactive IT will lead to more patients succeeding with their IT program.
SATURDAY
Abstracts S45
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2