Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

Rust, George; Zhang, Shun; Reynolds, Joshua C.

doi:10.3109/02770903.2013.799687

Cited by 48 publications

(41 citation statements)

References 26 publications

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“…BUKSTEIN [23] CAMARGO [22] HERNDON [26] ELKOUT [25] those who were less adherent [21][22][23]26]. RUST et al [21] (q=8) observed this protective effect only if adherence was measured as controller-to-total ratio.…”

Section: Objective Adherence Measurementsmentioning

confidence: 99%

“…Additionally, the number of prescriptions is also influenced by the quality and reliability of physicians prescribing. The best method to tease this out is by using a ratio of long-term controller to total asthma medications, in which the denominator and numerator increase with increasing severity, but the numerator is more specifically reflective of adherence to therapy [21].…”

Section: Discussionmentioning

confidence: 99%

“…RUST et al [21] (q=8) observed this protective effect only if adherence was measured as controller-to-total ratio. In contrast, if adherence was measured as proportion of prescribed days covered (PPDC), lower PPDC was associated with lower emergency department/ hospitalisation exacerbations.…”

Section: Objective Adherence Measurementsmentioning

confidence: 99%

“…MPR calculated across multiple refills is also called the continuous measure of availability. In addition to the MPR, two studies also calculated a controller-to-total ratio [21,27]. WILLIAMS et al [28] used a unique method to calculate adherence, by calculating a moving 6-month average ICS adherence for each day of follow-up.…”

Section: Measures Of Medication Adherencementioning

confidence: 99%

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Medication adherence and the risk of severe asthma exacerbations: a systematic review

et al. 2014

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The benefits of drug therapy for asthma have been well established, but adherence to treatment is poor, and this might be associated with an increased risk of asthma exacerbations. The aim of this study was to review the literature on the association between adherence to asthma controller treatment and risk of severe asthma exacerbations in children and adults.A systematic literature search was performed in PubMed, Embase and Web of Science, from inception until January 2014. Studies were included if data on the association between medication adherence and severe asthma exacerbations were presented. Quality was assessed using a modified version of the Newcastle-Ottawa Scale.The search yielded 2319 unique publications, of which 23 met the inclusion criteria and underwent data extraction and quality scoring. High levels of heterogeneity across studies with regard to adherence and exacerbation measurements, designs and analysis precluded a formal meta-analysis. Although effect measures varied widely, good adherence was associated with fewer severe asthma exacerbations in highquality studies.Good adherence tended to be associated with lower risk of severe asthma exacerbations. Future studies should use standardised methodology to assess adherence and exacerbations, and should consider inhaler competence.@ERSpublications High-quality studies indicated that better adherence is associated with fewer severe asthma exacerbations

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Section: Objective Adherence Measurementsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Objective Adherence Measurementsmentioning

confidence: 99%

Section: Measures Of Medication Adherencementioning

confidence: 99%

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Medication adherence and the risk of severe asthma exacerbations: a systematic review

et al. 2014

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“…Real-world patient adherence to ICSRx can be as low as 20%. 4,5 Initial ICS-Rx may be prescribed when the child is already experiencing frequent or severe exacerbations, a ''window of vulnerability'' for near-term exacerbation. Therefore, this study was undertaken to evaluate the incidence and timing of ED visits in the first 90 days after an initial ICS-Rx among Medicaid-enrolled children with asthma.…”

Section: Introductionmentioning

confidence: 99%

Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

Rust

Zhang²,

Holloway³

et al. 2015

Population Health Management

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Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICSRx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits.

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Adherence to airway clearance therapy in pediatric cystic fibrosis: Socioeconomic factors and respiratory outcomes

et al. 2015

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Summary Objectives The evidence linking socioeconomic status (SES) and adherence in cystic fibrosis (CF) is inconclusive and focused on medication uptake. We examined associations between SES, adherence to airway clearance therapy (ACT), and CF respiratory outcomes. Study Design Socioeconomic, clinical, and adherence data of CF patients (N = 110) at a single CF Center were evaluated in this cross-sectional observational study. SES was operationalized as maternal and paternal education and household income. Adherence to ACT was measured with utilization data from the high-frequency chest wall oscillation (HFCWO) device over 4–6 weeks. Statistical modeling was used to test three hypotheses: (H1) Higher SES is associated with higher ACT adherence; (H2) Higher SES is associated with better respiratory outcomes; and (H3) ACT adherence mediates the relationship between SES and respiratory outcomes. Results In multinomial logistic regression, maternal college education, annual income >$50,000, and more adults in the household were independently related to better adherence (P < 0.05). Paternal college education, income >$100,000, and lack of exposure to smoking were independently related to higher lung function (P < 0.05). Current adherence to ACT with HFCWO was not associated with lung function over 12 months. Conclusions SES is associated both with ACT adherence and respiratory outcomes in pediatric CF patients. However, the link between SES and respiratory outcomes in this study was not mediated by adherence to ACT with HFCWO. These data emphasize the importance of socioeconomic resources and household environment for CF health. Family socio-demographic profiles can help identify patients at increased risk for ACT nonadherence.

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Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

Cited by 48 publications

References 26 publications

Medication adherence and the risk of severe asthma exacerbations: a systematic review

Medication adherence and the risk of severe asthma exacerbations: a systematic review

Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

Adherence to airway clearance therapy in pediatric cystic fibrosis: Socioeconomic factors and respiratory outcomes

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