233 - Healthcare Providers’ Prescription Practices for Spacer Devices in Pediatric Asthma Care

Publication Number: 233.5529

Marina Reznik, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, United States; Jimmy Ibarra, Children’s Hospital at Montefiore - Albert Einstein College of Medicine, Bronx, NY, United States; Witness Chirinda, Children's Hospital at Montefiore - Albert Einstein College of Medicine, NY, NY, United States

Background: Asthma guidelines recommend that healthcare providers prescribe a spacer device for children to use with inhalers for optimal delivery of asthma medication. It is important to have the correct-fitting face mask for the spacer in order to deliver the full dose of medication. However, healthcare providers’ prescription practices vary, particularly in specifying mask sizes, which can impact medication delivery and asthma management.

Objective: To evaluate healthcare providers’ prescription practices regarding spacer devices for pediatric asthma patients, focusing on the factors influencing mask size specification.

Design/Methods: We conducted a cross-sectional self-administered anonymous survey with pediatric and family practice healthcare providers across 18 outpatient sites in the Bronx, New York. The survey assessed providers’ preferences for prescribing spacers with masks or mouthpieces, frequency of mask size specification, barriers to prescribing, and the influence of demographic and clinical factors. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression.

Results: A total of 149 providers participated. Providers preferred spacers with face masks for younger children (37% for ages 0–4 years), while mouthpieces were preferred for older children and adolescents (38% for ages 12–18 years). Pediatricians were more likely to specify mask sizes when prescribing spacers with masks than family medicine providers (56.1% vs. 26.3%, p = 0.003). Providers who assess inhaler-spacer technique during the visit were more likely to specify mask size than providers who do not assess the technique (54.0% vs 33.3%, p=0.017) (Table 1). Providers who frequently saw children with asthma were significantly more likely to specify mask sizes compared to those who saw them occasionally (OR = 2.64, 95% CI: 1.20-5.98, p = 0.017). Additionally, providers who reported patients bringing spacers to their visits were more likely to specify mask sizes (OR = 2.59, 95% CI: 1.26–5.47, p = 0.011) (Table 2). Providers cited insurance coverage issues, pharmacies not having spacers with masks in stock, and challenges in ordering spacers via Electronic Health Records (EHR) system as barriers. Possible solutions cited included having models of spacers in office and guidelines on what size mask to order.

Conclusion(s): Our results highlight the variability in providers' prescription practices for spacers and the role of provider characteristics on mask size specification. Future interventions should focus on improving provider education and addressing identified barriers to optimize pediatric asthma care.

Table 1: Factors associated with specifying the spacer mask size on prescriptions
# based on responses to the question ““Do you specify the size of a mask when prescribing a spacer with mask?”
Missing observations are excluded from the rows and columns; hence the totals may not add up for some of the columns
*Based on Fisher's Exact Test
#based on Pearson's Chi-square test with Yates' continuity correction
$subsample consisting of those who completed residency (n=69)



Table 2: Logistic regression analysis of factors associated with specifying of spacer mask size#
# based on responses to the question ““Do you specify the size of a mask when prescribing a spacer with mask?”
$ Responses were grouped into two categories: 'Frequently' (combining 1=Daily and 2=Several times a week) and 'Occasionally' (combining 3=Several times a month and 4=Rarely).