Patient-provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD

Med Care. 1998 Oct;36(10):1439-50. doi: 10.1097/00005650-199810000-00002.

Abstract

Objectives: Poor children's reliance on emergency facilities is one factor implicated in the rise of morbidity attributed to asthma. Although studies have examined doctor-patient communication during routine pediatric visits, little data are available about communication during emergency care. This study sought to describe communication during emergency treatment of childhood asthma to learn if a "patient-centered" provider style was associated with increased parent satisfaction and increased parent and child participation.

Methods: This cross-sectional, observational study examined 104 children aged 4 to 9 years and their guardian(s) attending emergency departments in seven cities. Quantitative analysis of provider-family dialogue was performed. Questionnaires measured satisfaction with care, provider informativeness, and partnership.

Results: Providers' talk to children was largely supportive and directive; parents received most counseling and information. Children spoke little to providers (mean: 20 statements per visit versus 156 by parents). Providers made few statements about psychosocial aspects of asthma care (mean: three per visit). Providers' patient-centered style with parents was associated with more talk from parents and higher ratings for informativeness and partnership. Patient-centered style with children was associated with five times the amount of talk from children and with higher parent ratings for "good care," but not for informativeness or partnership.

Conclusions: Communication during emergency asthma care was overwhelmingly biomedical. Children took little part in discussions. A patient-centered style correlated with increased parent and child participation, but required directing conversation toward both parents and children.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Asthma / psychology
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Communication*
  • Cross-Sectional Studies
  • Emergency Service, Hospital*
  • Female
  • Hospitals, Urban
  • Humans
  • Male
  • Patient Education as Topic
  • Patient Participation
  • Patient Satisfaction
  • Physician-Patient Relations*
  • Poverty
  • Professional-Family Relations*
  • United States
  • Urban Population