Care of asthmatic African Americans consistently falls short of standards set for treating the condition compared to care received by whites, according to a new national study of adults enrolled in managed care plans.
Researchers at Johns Hopkins University School of Medicine say the findings, reported Monday in the Archives of Internal Medicine, may help explain why African Americans are more likely to have severe asthma symptoms.
The study also found that women of both races are less likely to take medications daily as they're supposed to or to see an asthma specialist.
"The discrepancy is striking because it cannot easily be explained by socioeconomic factors or access to care," said Dr. Jerry Krishnan, an instructor at the school's division of pulmonary and critical care medicine and lead author of the study.
"We need to further investigate whether the differences were due to how doctors and other professionals provide care, how care is accepted or received by different patients or how a health system provides its care," Krishnan said.
System barriers could include such factors as whether doctors are easily available by phone or after hours, or how much difficulty a patient has in getting prescribed medications, the researcher explained.
Between 12 million and 15 million Americans, including 5 million children, have asthma, a chronic disease in which swelling and excess mucus in the airways blocks the flow of air in and out of the lungs.
The study was undertaken because other studies have shown that misuse and underuse of medications contribute to poor asthma care, but little was known about the relationship of gender and race to the condition, particularly the aspects of care recommended by national guidelines that don't involve taking medicine.
Researchers tracked the experience of more than 6,000 sicker-than-average asthmatic patients who were employees of some of the nation's largest companies and their dependents who had health coverage in a managed care plan.
The study found that fewer African Americans reported care consistent with guidelines set under the National Asthma and Education Prevention Program:
- Roughly 35 percent of black patients reported using inhaled corticosteroids daily, compared with 54 percent of white patients;
- Twenty-eight percent of African Americans said they were seeing a specialist for their asthma, versus 41 percent of whites;
- Forty-two percent of blacks said they had enough information about their condition to adequately manage an asthma attack, compared with 54 percent of white patients;
- And 38 percent of blacks said they got enough information about avoiding asthma triggers, compared with 54 percent of whites.
Although the study wasn't set up to consider patient preferences, the discrepancy in seeing a specialist doesn't seem to have been a matter of choice, "since many of these patients said they wanted to see a specialist," said Dr. Gregory Diette, a co-author of the report.
But in contrast to the differences in care by race, the researchers discovered that differences in care by gender were less pronounced. Women generally got better care than men, except in two areas. Fifty-eight percent of men took their medications daily, compared with 50 percent of women and 43 percent of men saw an asthma specialist, versus 38 percent of women.
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