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OBJECTIVE: To assess the extent to which caregivers and their child's physician agree about the prescribed asthma medication regimen and evaluate factors associated with medication concordance. METHODS: A cross-sectional, descriptive survey was administered to 318 caregivers of inner-city children with asthma, aged 5 to 12 years, and their caregiver-identified primary care physician at elementary schools and participants' homes. Concordance between caregiver- and physician-reported controller medication prescription was measured. RESULTS: Only 42% of physicians and 32% of caregivers reported a controller medication prescription (78% agreement, kappa = 0.54; 95% confidence interval: 0.45-0.63) despite that 73% of the children were rated by their caregiver as currently experiencing persistent asthma symptoms. When the physician reported a controller prescription, 38% of the caregivers denied use of a controller. Having a course of oral steroids in the past year (chi(2) = 9.85) and positive caregiver beliefs toward asthma care (chi(2) = 18.40) were associated with caregiver-physician concordance. Multivariate analysis found that when caregivers had high Asthma Beliefs Scale summary scores versus low scores, they were almost 10 times as likely to be concordant with the physician (odds ratio: 9.76; 95% confidence interval: 2.85-33.46). CONCLUSIONS: Our data support previous reports of physician underprescribing of controller medication among inner-city children. However, even when prescribed by a physician, more than one third of caregivers did not report a controller prescription, and this discordance was related to caregivers' beliefs about treatment. Efforts to improve physician adherence to asthma guidelines will not result in proper treatment unless caregiver-physician communication about asthma therapy is improved. [ABSTRACT FROM AUTHOR]