The Effect of Risk and Side Effect Communication on Asthma Medication Adherence

描述（由申请人提供）：哮喘是影响美国儿童的最常见慢性疾病。对于那些持续症状，最佳的哮喘症状控制是预测儿童每天服用控制药物。国家和国际共识小组都推荐吸入性皮质类固醇作为最有效的哮喘控制药物。然而，在所有控制药物类别中，儿童哮喘控制药物的依从性一直报告为较差。不依从哮喘控制药物的最常见原因是父母对哮喘控制药物的不信任和对不良事件的担忧，特别是生长速度和最终成人身高。由于一般医疗提供者而不是专家治疗大多数哮喘儿童，因此研究普通儿科医生如何沟通哮喘控制药物的风险和副作用非常重要。该研究是对2006年至2009年在五个农村普通儿科诊所收集的调查和诊所访问录音带的二级数据分析，其中包括35名儿科医生和296名持续哮喘症状的患者。将采用广义估计方程进行定量分析，以检查儿童、护理人员、儿科医生和药物特征对哮喘控制药物获益、风险和副作用讨论的影响。此外，拟议中的研究还将研究上述特征和关于益处、风险和副作用的讨论如何影响初次录音访视后一个月的对照药物依从性。研究还将定性描述访视期间发生的风险沟通。了解儿科医生如何与儿童及其护理人员就哮喘控制药物的益处、风险和副作用进行沟通，将使研究人员能够制定干预措施，改善儿科门诊访视期间的沟通。然而，很少有人知道儿科医生-儿童沟通有关哮喘控制药物。风险沟通研究是食品和药物管理局的优先事项，药物安全是医疗保健研究和质量机构的研究优先事项，进一步强调了这项拟议研究的重要性。来自拟议研究的数据可以为旨在改善患者与医生之间关于哮喘控制药物的风险和益处的沟通的干预策略提供信息。这些干预措施有可能改善对这些药物的依从性，从而：（1）减少旷课，（2）增加无症状天数，（3）减少哮喘急诊就诊，（4）减少护理人员的工作时间损失。 公共卫生相关性：哮喘是影响美国儿童最常见的慢性健康状况。食品和药物管理局的研究重点之一是风险沟通。这项拟议的研究将探讨如何在一般儿科诊所的医疗提供者讨论的风险，副作用和哮喘控制药物的好处与主要照顾者和儿童通过分析录音哮喘访问的成绩单。这项拟议的研究将探讨这些讨论是否与哮喘控制药物依从性有关，一个月后，哮喘访问录音。

DESCRIPTION (provided by applicant): Asthma is the most common chronic disease affecting US children. For those with persistent symptoms, optimal asthma symptom control is predicated on children taking daily control medications. Both national and international consensus groups recommend inhaled corticosteroids as the most effective asthma control medication. However, adherence to asthma control medications in children is consistently reported as poor across all control medication classes. The most common reasons for non-adherence to asthma control medications are parental distrust of asthma control medication and concerns over adverse events, especially growth velocity and final adult height. Since general medical providers rather than specialists treat most asthmatic children, it is important to study how general pediatricians communicate about the risks and side effects of asthma control medications. The proposed research is a secondary data analysis of survey and clinic visit audio - tapes that were collected in five rural general pediatric practices from 2006 through 2009 including 35 pediatricians and 296 of their patients with persistent asthma symptoms. Quantitative analyses employing generalized estimating equations will be conducted to examine the influence of child, caregiver, pediatrician, and medication characteristics on discussions of benefits, risks, and side - effects of asthma control medications. In addition, the proposed research will also examine how the above characteristics and discussions about benefits, risks, and side - effects affect control medication adherence one month after the initial audio - taped visit. The study will also qualitatively describe the risk communication that occurs during the visits. Understanding how pediatricians communicate with children and their caregiver(s) about the benefits, risks, and side - effects of asthma control medication will enable researchers to develop interventions that can improve communication during a pediatric office visits. However, very little is known about pediatrician- caregiver-child communication about asthma control medications. Risk communication research is a priority of the Food and Drug Administration and medication safety is a research priority of the Agency of Healthcare Research and Quality further highlighting the importance of this proposed research. Data from the proposed research could inform intervention strategies designed to improve patient-physician communication about the risks and benefits of asthma control medications. Such interventions have the potential to improve adherence to these medications and subsequently: (1) reduce absenteeism from school, (2) increase symptom - free days, (3) decrease asthma emergency department visits, and (4) reduce time lost from work for caregiver(s). PUBLIC HEALTH RELEVANCE: Asthma is the most common chronic health condition affecting US children. One of the Food and Drug Administration's research priorities is risk communication. This proposed research will examine how medical providers in general pediatric clinics discuss the risks, side effects, and benefits of asthma controller medications with primary caregivers and children by analyzing transcripts of audio taped asthma visits. This proposed research will then explore whether those discussions are related to asthma controller medication adherence one month after the audio taped asthma visit.