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Responsibility for Asthma - Who's Taking Care?

Lynn M. Olson, PhD 1, Linda Radecki, MS 1 and Kevin B. Weiss, MD, MPH 2. 1 Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL, United States, 60007 and 2 Center for Healthcare Studies, Northwestern University & Hines VA Hospital, Chicago, IL, United States, 60611.

Background: Responsibility for care away from the physician's office is an important clinical issue in pediatric asthma management. Who takes the onus for management - parent or child? How do these issues relate to medication compliance?

Objective: To assess parent and child report of asthma management and medication compliance.

Design/Methods: Children & parents completed a questionnaire on asthma responsibility as part of a larger study to examine children's ability to report on their own health status.

Results: 409 parent-child dyads completed questionnaires. 59% of the children were male; child age M=10.9 years; 47% African American; 12% identified as Hispanic/Latino. Mean sx days in the previous 2 weeks reported by parent and child was 3.2 and 3.0 days, respectively. Asked how often the child takes medications on his/her own, 65% of parents reported "all or pretty much" of the time; child report of self-responsibility for medication use was 68%. Parent-child agreement on responsibility for medication use was 68%. Based on parent report, over 1/4 (28%) of children took their medications as prescribed only "some to none" of the time. Among parents who reported poor compliance, over 50% also reported that the child took meds by self "pretty much" to "all" of the time (X2=15.1, p<.01). Parent account of child responsibility for medication increased with child age - 50% of 7-9 year olds had primary responsibility while 78% of 14-16 year olds had a similar level of responsibility for own medication use. No differences in compliance or child responsibility for medication were found by family income, education, marital status, or own asthma status.

Conclusions: A majority of families report it is the child who has primary responsibility for taking asthma medications. These findings suggest a critical need to consider what happens when children leave the office setting and to provide developmentally appropriate education regarding why, how and when asthma medications should be taken.

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