Parent’s trust in doctor is key for black asthmatic children

Children under 12 with persistent asthma need highly motivated parents if they are to get the benefits of regular steroid inhaler treatments and have fewer asthma attacks. That motivation starts with a good relationship between parent and doctor.

But in a recent survey, African American parents rated their children's doctors lower than white parents did in qualities that are linked to better adherence with asthma medications, report University of Michigan researchers.

"For the parents who did not give the medications as prescribed, we found specific characteristics of their experience with the doctor that were associated with less adherence," says Kathryn L. Moseley, M.D., an assistant professor of pediatrics at the U-M Medical School.

The U-M results suggest that improved physicians' relationships with these parents could help reduce the frequency of asthma attacks and hospitalizations among minority children.

One way to improve parents' trust and confidence is for clinics to make sure that parents with children who have persistent asthma see the same doctor each time if possible, Moseley says. During office visits, doctors could make sure that parents feel that their questions and concerns are fully addressed, says Moseley. The study, which appears in the May issue of the Journal of the National Medical Association, also shows that parents who are not adhering to asthma treatments are in many cases not getting flu shots for their children.

Children who don't get regular steroid inhaler treatments for their asthma are at higher risk of complications from influenza. So there's an added reason for physicians to work to increase rapport with minority parents.

Insurers as well as physicians may want to act on the study results. Some insurers target messages to their clients to encourage better preventive care to save costs, Moseley says.

"They might want to create specific interventions to encourage parents to get flu shots for their children and also ask, 'Any problems with giving the inhaler doses?'"

Study details Moseley and her colleagues interviewed 282 parents of children aged 2 through 12 who had asthma-related physician visits in 2004 and 2005. Parents were asked about their children's use of steroid inhalers and about vaccination against influenza. The researchers also adapted a well-known questionnaire, the Primary Care Assessment Survey, to measure parents' perceptions about their encounters with their child's physician.

Black parents in the survey did not have some of the common obstacles to regular asthma care, such as lack of insurance or a family doctor.

"We studied a highly insured population who go to the doctor's office," Moseley says. "Even in this population, black parents rated their physicians lower than white parents on all the scales associated with asthma adherence."

The results suggest that for these parents, their children's doctors did not inspire a high degree of trust. Patients feel they can trust doctors who seem to be looking out for their best interests and convey a sense of competence, other studies have shown.

"Parents want to feel, 'This doctor has my child's best interests at heart,'" says Moseley. "Doctors convey this by looking parents in the eye, calling the patient and the parent by name, and appearing not to be rushed. Asking 'What questions do you have?' lets the parent know that the doctor wants them to understand their child's plan of treatment."

Ericka J. Hudson, M.H.S.A., a research associate at the U-M Child Health Evaluation and Research Unit, is also an author of the study.

The study was funded by the Blue Cross Blue Shield of Michigan Foundation.

Citation: Journal of the National Medical Association, Vol. 101, No. 5, May 2009