Community health centers and clinics typically don't have the resources to provide quality asthma care to underserved children, who often belong to racial or ethnic minority groups. However, even in private practices, these children receive fewer asthma medications than similarly sick white children. Programs to eliminate these disparities will need to focus on the site of care and also to intervene at the provider and patient levels to be successful, according to the study's lead author, Alexander N. Ortega, Ph.D., of Yale University School of Medicine, and Peter J. Gergen, M.D., of the Agency for Healthcare Research and Quality.
In the Childhood Asthma Severity Study, Drs. Ortega and Gergen and their colleagues analyzed information from patient-reported questionnaires and prescription, demographic, provider, and other data on a community sample of 1,000 asthmatic children and their families from two States (Connecticut and Massachusetts). Inhaled bronchodilators (to open up the lungs to ease breathing) and steroids (to prevent or reduce airway inflammation and asthma episodes) are standard-of-care asthma medications. Yet, black and Hispanic children received fewer bronchodilators, and Hispanic children received fewer inhaled steroids than white children, after adjusting for site of care, insurance status, symptom severity, and other factors.
Analysis of private practices alone revealed significantly lower inhaled steroid use among Hispanic children. Differences in bronchodilator use by race and ethnicity changed little but did become nonsignificant, perhaps because the sample size was too small to reveal a difference. The only care difference by practice site was that a higher proportion of children in private practices (15 percent) used inhaled steroids for 1 month or more compared with 7 percent of those seen either in outpatient care centers or hospital-based clinics. Overall, a large proportion of children had not used inhaled steroids in the past year: 73 percent of whites, 88 percent of blacks, and 94 percent of Hispanics. Also, 18 percent of white children had not used beta-agonists in the past year compared with 27 percent of black children and 22 percent of Hispanic children.
See "Impact of site of care, race, and Hispanic ethnicity on medication use for childhood asthma," by Drs. Ortega and Gergen, A. David Paltiel, Ph.D., and others, in the January 2002 Pediatrics 109(1).Reprints (AHRQ Publication No. 02-R046) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.