Minal R. Patel, MPHDoctoral StudentDepartment of Health Behavior & Health Education University of Michigan School of Public Health

Perceived caregiver financial

barriers and asthma outcomes in

urban elementary school children

American Thoracic Society International Conference , New Orleans, Louisiana

May 15, 2010

Disclosure Statement

Authors have no conflicts of interests or disclosures to report Minal R. Patel, Melissa A. Valerio, Michael D. Cabana, Janet

M. Coffman, Noreen M. Clark

Study was supported by the National Institutes of Health, National Heart Lung Blood Institute (NIH: HR-56028)

Background

Asthma affects 5.1 million children (Centers for Disease Control )

Higher hospital readmission rates, emergency department re-visits, & more missed school days Neighborhood level poverty (Liu & Pearlman; Halfon & Newacheck)

Persistent asthma severity (Moonie et al.; Walsh-Kelly et al.; Clark et al. 2004)

Background

Financial pressures & disease management

Out-of-pocket costs have been shown to lead to medication underuse and higher use of acute care. (Bender and Rand 2004; Wagner et al., 2008).

The potential impact of a caregiver’s perceptions about cost barriers to obtaining asthma care for their children is not well understood.

Research Question

Is there an association between caregiver perception of financial barriers and health outcomes in their children?

Data Source

Partnership to Control Asthma in Public Schools intervention(Clark et al. 2004)

Design: Randomized controlled trial Baseline caregiver interviews

Demographic characteristics Asthma control Insurance status Health care utilization Missed school days Perceived financial barriers

Study Participation

Initially approached6,351

Returned survey4,576

Eligible to participate

1,217

Agreed to participate

835

Sample (N=835) Caregivers of children with asthma in grades 2-5

Recruitment Inclusion criteria

Analysis

Simple frequencies and descriptive statistics

Chi-square analysis

Multiple logistical regression analysis

Results- Child Characteristics

Factor %

Age (M, SD) 8.40 (1.29)

Sex (% male) 53%

African American 94%

Asthma medication use

Reliever 43%

Controller 16%Asthma Control

Well controlled 69%

Not well/poorly controlled 31%

Results- Household Characteristics

Factor %

Perceived financial barriers (% yes) 9%, (79)

Medicaid 10%

No Insurance (reported at BL) 80%

Income below $40,000 82%

Head of household (% mother) 75%

Results- Associations between perceived financial barriers, household, and child’s asthma

characteristicsFactor Perceived financial barriers due to

asthma N (%)P-value

Yes No

Annual household income

<0.01

<$20,000 58 (76%) 395 (57%)$20,001 - $40,000 13 (17%) 172 (25%)$40,001 - $60,000 4 (5%) 87 (12%)

>$60,001 1 (2%) 44 (6%)Insurance Status NS

Private (% yes) 8 (57%) 74 (47%)Medicaid (% yes) 5 (36%) 81 (52%)

No insurance 65 (82%) 599 (79%)Asthma control <0.0001

Well controlled 31 (39%) 548 (73%)Not well controlled 26 (33%) 105 (14%)Poorly controlled 22 (28%) 102 (13%)

Results- Multivariate Model

Variable Multivariate OR [95% CI]

Emergency department

visits

Hospitalizations

Missed school days

Perceived

financial

barriers (Yes)

2.17 [1.30 to

3.60]**

4.63 [2.40 to

8.92]**

3.76 [1.86 to

7.60]**

Significant Association <0.05* ; <0.01**

Summary of Findings

The majority of caregivers did not perceive financial barriers in obtaining care for their child’s asthma

Parents of lower income and/or with a child whose asthma is not controlled may be more likely to see barriers to receiving care despite insurance status.

Poor outcomes for children were associated with parents’ perceptions of financial barriers to obtaining asthma care.

Limitations

Population predominately African American

Self-report- recall (Cabana et al. 2006; Martin et al., 2000)

Small number of asthma-related acute care events

Implications

Caregiver perceptions have consequences on outcomes

Health care providers can ask caregivers if they perceive specific financial barriers in obtaining medicine and asthma devices

Adjust their clinical recommendations

Prescribe generics or insurance-covered medicines

Refer patients to local community organizations or pharmaceutical assistance programs

Acknowledgments

Thank you to: Noreen M. Clark, PhD

Melissa A. Valerio, PhD, MPH

Michael D.Cabana, MD, MPH

Janet M. Coffman, PhD, MPP

Colleagues at the Center for Managing

Chronic Disease