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Minal R.

Patel, MPH
Doctoral Student
Department 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
 Partnershipto 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 approached
6,351
Sample (N=835)
 Caregivers of
Returned survey
4,576 children with asthma
in grades 2-5
 Recruitment

 Inclusion
Eligible to
participate criteria
1,217

Agreed to
participate
835
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
characteristics
Factor Perceived financial barriers due to asthma P-value
N (%)
Yes No

Annual household <0.01


income
<$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 Hospitalizations Missed school


department days
visits
Perceived 2.17 [1.30 to 4.63 [2.40 to 3.76 [1.86 to
financial
3.60]** 8.92]** 7.60]**
barriers (Yes)

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