Asthma Controller Medication Adherence, Risk of Exacerbation, and Use of Rescue Agents Among Texas Medicaid Patients with Persistent Asthma

Makhinova, Tatiana; Barner, Jamie C.; Richards, Katherine; Rascati, Karen L.

doi:10.18553/jmcp.2015.21.12.1124

Cited by 57 publications

(50 citation statements)

References 57 publications

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“…In the present study, notwithstanding the high rate of antiasthma therapy adherence, patients with a partial/poor adherence had a higher exacerbations risk (OR 2.54), in line with a recent review showing that a good adherence was associated with lower risk of severe asthma exacerbations . Indeed, adherence to antiasthma controller medications is one of the key drivers to improve persistent asthma management …”

Section: Discussionsupporting

confidence: 89%

RItA: The Italian severe/uncontrolled asthma registry

Maio

Baldacci

Bresciani

et al. 2017

Allergy

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Section: Discussionsupporting

confidence: 89%

RItA: The Italian severe/uncontrolled asthma registry

Maio

Baldacci

Bresciani

et al. 2017

Allergy

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“…Poor adherence to asthma control medication is associated with the risk of developing AEs that require oral corticosteroids. 28 One of the relevant factors in medication adherence is incorrect inhaler technique in asthma treatment. 29 In contrast, patients suffering from more frequent exacerbations are likely to comply with their asthma medication regime.…”

Section: Discussionmentioning

confidence: 99%

Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children

2016

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Background and objective: Fractional exhaled nitric oxide (FeNO) has been used as a marker for airway inflammation. We evaluated the association between FeNO levels and asthma exacerbations (AEs) in Thai children and young adults. Methods: This was a prospective cohort study in patients with atopic asthma aged 7-20 years. Asthma control level and management were evaluated every 3 months for 1 year. Spirometry and FeNO measurements were performed at baseline, and 6 and 12 months. Results: In all, 70 patients (median age: 12.6 (7.2-19.8) years) were enrolled, of whom 18% had an AE during the study period. Median FeNO levels were significantly higher in patients with an AE than in those without an AE (35.6 ppb vs 16.5 ppb; P = 0.012). FeNO of 31 ppb provided optimal sensitivity (92.3%) and specificity (75.4%) for AE prediction. Sensitivity and specificity of FeNO levels were higher than those of forced expiratory volume in 1 s and forced expiratory flow at 25-75% of forced vital capacity bronchodilator reversibility for the prediction of an AE, but the difference was not significant (P = 0.121). None of the patients with FeNO level of 0-20 ppb had an AE within 12 months. Percentage of patients with FeNO of 21-40 ppb who suffered an AE was 20% and 30% at 6 and 12 months, respectively. Conclusion: The optimal cut-off point of FeNO level for the prediction of AE is 31 ppb. AE within the next 12 months was significantly more common in patients with higher FeNO levels and in patients with a higher rate of previous 12-month exacerbations.

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“…A recent study of children and adolescents in the Texas Medicaid population revealed that average adherence to all types of controller strategies was only 32%. 17 In that study, only 4% of patients achieved an adherence rate of 80% based on the proportion of days covered. Clinicians, particularly in the context of a busy day of seeing patients, rarely have time or systems in place to reliably check a patient's inhaled controller refill history.…”

Section: Inhaled Asthma Controllersmentioning

confidence: 81%

Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities

Helm¹

2017

Pediatrics

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Value-based insurance design (VBID) represents an innovative approach to health insurance coverage. In the context of pharmacy benefits, the goal of VBID is to minimize access barriers to the most effective and appropriate treatments for specific medical conditions. Both private and public insurance programs have explored VBID pharmacy projects primarily for medical conditions affecting adults. To date, evidence for VBID pharmacy programs for children and youth with special health care needs (CYSHCN) appears lacking. There appears to be potential for VBID concepts to be applied to pharmacy coverage benefiting CYSHCN. An overview of VBID pharmacy principles and guiding principles are presented. Opportunities for the creation of pharmacy programs with a value-based orientation and challenges to the redesign of pharmacy benefits are identified. VBID pharmacy coverage principles may be helpful to improve medication use and important clinical outcomes while lowering barriers to medication use for the population of CYSHCN. Pilot projects of VBID pharmacy benefits for children and youth should be explored. However, many questions remain.

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Asthma Controller Medication Adherence, Risk of Exacerbation, and Use of Rescue Agents Among Texas Medicaid Patients with Persistent Asthma

Cited by 57 publications

References 57 publications

RItA: The Italian severe/uncontrolled asthma registry

RItA: The Italian severe/uncontrolled asthma registry

Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children

Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities

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