Adherence to Therapy and Access to Care: The Relationship to Excess Asthma Morbidity in African-American Children

Current evidence suggests that asthma morbidity and mortality are disproportionately high among African-American children. Poor adherence to asthma medications and inadequate primary care have been implicated as important factors in the high rates of emergency room care and hospitalization. This paper reviews and discusses research on access to health care and adherence to asthma therapy among low-income and minority populations, and their relationship to asthma morbidity and mortality in African-American children. Drawing on a model of access to personal health care services, proposed by the Institute of Medicine's Report on Access to Care, we hypothesize excess asthma morbidity among African-American children in urban communities may be attributed to several interrelated reasons, including poor adherence to therapy resulting from personal barriers (e.g., lack of parental knowledge about asthma management, folk illness beliefs and behaviors) and poor access to care resulting from structural barriers (e.g., lack of primary caretaker, organizational impediments) ana financial barriers (e.g., trouble paying for primary care visits or prescriptions).