Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence

ABSTRACT

Objective: Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed. Methods: Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics. Results: Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p <.05) from baseline to follow-up. Knowledge and Between-Provider Communication improved significantly (p <.05) within all four sites; Access improved significantly in Chicago, Philadelphia, and Puerto Rico; Trust improved significantly in Chicago, Los Angeles, and Philadelphia; and Patient-Provider Communication improved significantly in Philadelphia only. Conclusion: Pediatric asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children.

KEYWORDS:

• Education
• management/control
• prevention

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

Funding for this study came from the Merck Childhood Asthma Network, Inc. (MCAN), a nonprofit, 501(c)(3) organization, that was funded from 2005–2015 by the Merck Foundation. One author (FJM, MCAN Executive Director) was a Merck employee and played a role in the study design; in the interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. MCAN did not, and was not permitted to, promote the commercial products of Merck. We would also like to acknowledge Kelsey Thome for her help with manuscript preparation.