An evaluation of physicians’ engagement of children with asthma in treatment-related discussions

Abstract

Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8–16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider–child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.

Disparities in assessments of asthma control between children, parents, and physicians

“…42 One group which used audio-tape recently reported that both children (8-16 years old) and parents were asked for their input into asthma treatment plans during only 7.8% and 9%, respectively, of visits, 43 and that one third of providers did not ask these children any treatment-related questions. 44 Our finding that disagreement between the physician, whether pediatrician or pediatric pulmonologist, and the child is significantly greater when the parents have a higher level of education or when the physician believes there is good adherence to the inhaled steroids treatment is of interest. It suggests that physicians may be biased by impression.…”

Exploring the theoretical pathways through which asthma app features can promote adolescent self-management

“…Adolescents believed these features could enhance asthma-related communication with school nurses, friends, and providers, which is an important domain of asthma self-management [12]. Because providers often ask adolescents how often they use their control and rescue medications and experience with symptoms, data collected via apps that can be displayed in an easy-to-read graphical format could potentially enhance adolescent-provider communication during office visits [45]. These data could also potentially be transmitted directly to the child's electronic health record [46].…”

The relationship between patient–provider communication and quality of life for children with asthma and their caregivers

“…Other analyses with these data have shown that even though children and caregivers express problems with their asthma medications, they are very unlikely to ask questions about these problems during the visit [42]. Moreover, additional analyses have revealed that even though over 95% of children in the study wanted to be involved in treatment-related discussions, one-third of providers did not ask children any treatment-related questions [43]. Taken together, these findings suggest that providers may need assistance with creating an environment where families can engage more in asthma-related discussions.…”