Racial/ethnic disparities in the pharmacological management of pediatric asthma patients

Pediatric patients have often received medications that are not effective in the management of their asthma. In 1991, in response to this situation, the National Heart, Lung, and Blood Institute (NHLBI) created the National Asthma Education and Prevention Program (NAEPP) composed of a panel of international experts who recommended a new treatment focus, which offered a treatment shift away from calming acute flare-ups to preventing serious attacks. It emphasized corticosteroid anti-inflammatory drugs as the foundation for the preventive treatment of asthma. The recommendations were published in the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. This study analyzes data from the Medical Expenditure Panel Survey (MEPS). It uses a multinomial logit regression to predict the probability of a pediatric asthma patient receiving appropriate medications as outlined in the NAEPP Guidelines. Results show that African-American pediatric asthma patients are less likely to receive the medications the NAEPP Guidelines deem appropriate; they are more likely to receive either no medication or medications that do not control asthma symptoms effectively. Both African-Americans and Latinos are least likely to receive the recommended combination of medications---a beta 2-agonist and an inhaled corticosteroid. Whether or not a patient has either income or insurance had no effect on the results, therefore there is a factor external to the model, which is influencing the results. The catalyst for this difference may be the provider. He/she alone can bring about differences between racial groups. Through a clear understanding and through everyday practice of culturally competent medicine these differences in prescribing habits could be decreased. Therefore, there is an increased need for more emphasis on cultural competence by medical schools and policy makers.