Paper
Thursday, July 14, 2005
Medication Adherence among Low-Income Children with Asthma
Alice Demi, RN, DNS, FAAN1, Marianne Celano, PhD2, Roger Bakeman, PhD3, Traci Sims, BS1, and Rhoda Murray, BS1. (1) Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA, (2) Grady Health System, Atlanta, GA, USA, (3) Psychology, Georgia State University, Atlanta, GA, USA
| Learning Objective #1: Identify variables related to medication adherence among low-income children with asthma |
| Learning Objective #2: Identify methods to assess adherence to medication regimen of low-income children with asthma |
Poor adherence to asthma treatment increases the likelihood of mortality, hospitalizations, and emergency department visits, especially for low income children. The aims of this study were to describe treatment adherence and examine how family systems variables are related cross-sectionally to medication adherence for 6 to 11 year old low income children with asthma. Findings presented here are from the baseline assessment of a larger study. Based on a conceptual model adapted from the Biobehavioral Family Model (BBFM), we hypothesized that greater adherence will be predicted by high levels of family cohesion, parent responsivity, and consistent discipline. One-hundred-ten children with persistent asthma were recruited from two pediatric clinics and an emergency center at an urban hospital. Data were collected by nurses during home visits. Mean daily adherence (MDA) to Flovent, Serevent and Singulair was measured by electronic monitoring devices (MDI Log IITM or MEMS TrackCapTM) over a 14 day period. Urine samples were tested for cotinine, a biochemical measure of exposure to environmental tobacco smoke (ETS). Videotaped MDI/spacer technique was rated by trained nurses. The average age of the children was 8.63 years, 69% were male, and 97% were African American. Caregivers were predominantly females (97%), mothers to the index child (88%), not married (72%), receiving Medicaid (66%), with household incomes lower than $18,000 (70%). Most children were prescribed Flovent and about half were prescribed Singulair, with approximately 1/3 prescribed both medications. Mean Daily Adherence to Flovent, Serevent, and Singulair were calculated and MDI technique was assessed. Family report of a smoker in the household was correlated with cotinine/creatinine ratios in excess of 30 ng/mg in children's urine. Regression analyses were used to determine the unique contributions of family systems variables to the prediction of medication adherence.