Physician Behavior in the Care of Pediatric Chronic Illness: Association With Health Outcomes and Treatment Adherence

Objective: Physician behavior is an important but understudied influence on child and parental adherence to medical treatment. Method: To address this need, research was reviewed in the following topic areas: child and adolescent perceptions of physicians' behavior in pediatric chronic illness management, parental perceptions of physicians' behavior in pediatric chronic illness management; physicians' adherence to guidelines for pediatric chronic illness management; physicians' communication of information concerning pediatric chronic illness treatment; the relationship of physician behavior to treatment adherence; and interventions to enhance physicians' management of pediatric chronic illness. Results: Findings underscore discrepancies between the needs of parents and adolescents and physician behavior as well as inconsistencies in physician behavior, including adherence to practice guidelines, which may limit children's adherence to medical treatment. However, results of interventions designed to enhance physicians' management of pediatric asthma have been promising. Conclusions: Future research should be guided by a comprehensive model of physician behavior in chronic illness management that considers contextual determinants (e.g., culture and socioeconomic status), identifies clinically relevant targets for intervention, and documents the impact on health outcomes. Approaches to chronic illness management that involve physicians in active communication, support, and decision making with children with chronic illness and their parents should be developed and evaluated. (J Dev Behav Pediatr 30:246-254, 2009)