Use of asthma management plans: Challenges to achieving national compliance standards

Asthma continues to be the most common chronic childhood illness in the United States (US). The National Asthma Education and Prevention Program (NAEAPP) was established in the 90's to raise awareness about asthma with the intent of improving care and outcomes. The concept of daily management as opposed to episodic treatment (in particular, developing and using an asthma management plan) was established as the preferred approach to asthma management. In a study examining parents' perceptions of access to care and ED use, parents were asked about their knowledge specific to their child's asthma. A sample of 50 parents of children with asthma, who were admitted to a Southeastern U.S. Emergency Department, constituted the study group. Each family underwent a semi-structured interview using the modified Barriers to Care Questionnaire. The Asthma Data Collection tool was used to guide the interview process and used to document the parent/guardian's answers using a semi-structured interview. Section I of the Asthma Data Collection Tool includes demographic data: age, gender, race, type of insurance, admission and discharge date and Respiratory Score on admission to the ED. Section II includes 22 questions regarding the child's asthma care, including the reasons for ED admission, perceived access to the primary care provider (PCP), perceived quality of asthma care by the PCP, current asthma medications, perceived barriers to obtaining medications, sources for and perceived adequacy of information on child asthma care, and presence and understanding of an asthma management plan. Relationships between variables were tested using crosstabs and chi square analysis. SPSS version 17.0 was used to complete analysis of frequencies, measures of central tendencies, cross tabs and chi square analyses. NVivo 8, a qualitative analysis software package, was used to analyze the data from the open-ended questions obtained during these interviews. Statistically significant relationships were found between insurance status and access to PCP asthma management and affordable medications, as well as the perceived quality of care. In addition, the majority of families did not have an asthma management plan or a good understanding of medications, treatments and/or how to manage symptoms. Lack of an asthma management plan and low levels of understanding were significantly related to frequency of ED use. It is evident that we have not been successful in fully implementing the national standards of care for pediatric asthma. There is need for further study regarding the barriers to compliance with the national standards.