Concordance among children, caregivers, and clinicians on barriers to controller medication use.
OBJECTIVE
While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad.


METHODS
We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads.


RESULTS
Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence.


CONCLUSIONS
There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.
['Arnold|Carolyn M|CM|', 'Bixenstine|Paul J|PJ|0000-0003-4160-9448', 'Cheng|Tina L|TL|', 'Tschudy|Megan M|MM|']
D000293:Adolescent D001741:African Americans D001249:Asthma D001291:Attitude of Health Personnel D017028:Caregivers D002648:Child D005260:Female D006801:Humans D007407:Interviews as Topic D008297:Male D055118:Medication Adherence D012720:Severity of Illness Index D012959:Socioeconomic Factors D014505:Urban Population
Medication adherence mixed methods community pediatrics cross-sectional design family–clinician discordance