Barriers to Prescribing Controller Anti Inflammatory Medication among Puerto Rican Asthmatic Children with Public Insurance: Results of National Survey of Pediatricians.

BACKGROUND: There are substantial disparities in dispensing patterns of long term control medications for asthma among children in Puerto Rico with public insurance as compared to those with private insurance. Public health insurance policy in Puerto Rico includes the cost of medications in the capitation paid to the primary care physicians and clinics. METHODS: Survey questionnaires were mailed to all pediatricians enrolled in the Puerto Rico College of Physicians (n=798) in addition to some pediatricians not enrolled in the College (n=25) for a total of 823 pediatricians. Of these, 722 were eligible pediatricians with 458 responding to the survey for a response rate of 63.4%. RESULTS: Most of the respondents expressed being moderately to very familiar with the National Asthma Education and Prevention Program (NAEPP) guidelines (71.7%) and with the NAEPP recommendations for controller asthma medication use (73.5%). Inadequate capitation to cover asthma medication (86.2%) and lack of adequate health insurance coverage of the patient (83.2%) however, were the most frequent barriers reported by pediatricians for prescribing controller asthma medication to children with public health insurance. The most frequent strategies used to provide controller asthma medication to these children were prescription of oral medications (59.5%) and giving away samples (44.7%). CONCLUSIONS: Current public health insurance policy in Puerto Rico creates a disincentive to the appropriate prescription of long term control medication for children with asthma. To improve the quality of asthma care of children in Puerto Rico, revision of this public health insurance policy is necessary.

Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families.

This paper describes the process for and safety/feasibility of adapting the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families. Utilizing a Stage I model for protocol development, the adaptation involved literature review, focus groups, pilot testing of the adapted manual, and open trial of the adapted intervention with 9 families experiencing maternal depression. Adaptations included conducting the intervention in either Spanish or English, expanding the intervention to include the contextual experience of Latino families in the United States with special attention to cultural metaphors, and using a strength-based, family-centered approach. The families completed preintervention measures for maternal depression, child behavioral difficulties, global functioning, life stresses, and an interview that included questions about acculturative stressors, resiliency, and family awareness of parental depression. The postintervention interview focused on satisfaction, distress, benefits of the adapted intervention, and therapeutic alliance. The results revealed that the adaptation was nonstressful, perceived as helpful by family members, had effects that seem to be similar to the original intervention, and the preventionists could maintain fidelity to the revised manual. The therapeutic alliance with the preventionists was experienced as quite positive by the mothers. A case example illustrates how the intervention was adapted.