Multifaceted interventions improve medication adherence and reduce acute hospitalization rates in medicaid patients prescribed asthma controllers

Gelzer, Andrea; Gao, Wanzhen; Keleti, D.; Donia, T; Megargell, L.; Kreitman, J.; Michael, Karen

doi:10.1080/02770903.2018.1439954

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…On the other hand, improper inhaler technique may worsen drug adherence. Thus, educational programs, which are inexpensive and effective, may help in preventing the development of loss of asthma control.15,16…”

Section: Discussionmentioning

confidence: 99%

<p>Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study</p>

Tomisa

Horváth

Szalai

et al. 2019

JAA

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BackgroundRisk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort.MethodsA cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used.ResultsOf 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV1, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV1 (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81).ConclusionsThis study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV1, and poor adherence to treatment having the highest impact.

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Section: Discussionmentioning

confidence: 99%

<p>Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study</p>

Tomisa

Horváth

Szalai

et al. 2019

JAA

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“… 18 , 27 , 33 , 38 , 39 , 41 , 44 , 46 , 51 , 55 , 56 , 63–65 The study population consisted of 1,001,662 adolescents and adults with physician diagnosis of asthma in any population-based administrative database. More than one-third (n = 13) of the studies observed adherence and clinical outcomes (ie, asthma exacerbation, emergency room visits) simultaneously 14 , 15 , 17 , 18 , 28 , 30 , 31 , 34 , 37 , 40 , 45 , 48 , 56 while three studies assessed the association between medication adherence and cost of asthma. 43 , 49 , 57 The occurrence of the targeted clinical outcome was assessed from 12 months to 10 years.…”

Section: Resultsmentioning

confidence: 99%

“… During the post index period, compared to the Fluticasone propionate (FP), adherence was significantly higher in the Mometasone furoate delivered through a dry powder inhaler (MF-DPI) cohort (23.5% vs 14.5%; p < 0.0001) and prescription fills (2.70 vs 1.91; p < 0.0001). Gelzer et al 30 The study included 3589 Medicaid members claims that have a primary diagnosis of asthma (ICD-9, 493.xx) and prescription fills for asthma controllers. Two arm retrospective cohort study with one year follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…A fixed interval PDC was calculated as the ratio of the number of days a patient had medication on hand to the total number of post-index days (ie, 365 days). 15 , 21 , 29 , 30 , 33 , 35 , 36 , 42 , 47 , 50 , 51 , 53 , 59 …”

Section: Resultsmentioning

confidence: 99%

“…Only two studies assessed adherence and the impact of treatment groups or covariates on it as a continuous variable. 30 , 45 Thus, researchers did not set adherence cut-off.…”

Section: Resultsmentioning

confidence: 99%

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Measuring Medication Adherence in a Population-Based Asthma Administrative Pharmacy Database: A Systematic Review and Meta-Analysis

Asamoah-Boaheng

Bonsu

Farrell

et al. 2021

CLEP

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Background Limited studies have systematically reviewed the literature to identify and compare the various database methods and optimal thresholds for measuring medication adherence specific to adolescents and adults with asthma. In the present study, we aim to identify the methods and optimal thresholds for measuring medication adherence in population-based pharmacy databases. Methods We searched PubMed, Embase, International Pharmaceutical Abstracts (IPA), Web of Science, Google Scholar, and grey literature from January 1, 1998, to March 16, 2021. Two independent reviewers screened the studies, extracted the data, and assessed the quality of the studies. A quantitative knowledge synthesis was employed. Results Thirty-eight (38) retrospective cohort studies were eligible. This review identified 20 methods for measuring medication adherence in adolescent and adult asthma administrative health records. Two measures namely the medication possession ratio (MPR) and proportion of days covered (PDC) were commonly reported in 87% of the literature included in this study. From the meta-analysis, asthma patients who achieved adherence threshold of “0.75–1.00” [OR: 0.56, 95% CI: 0.41 to 0.77] and “>0.5” [OR: 0.71, 95% CI: 0.54 to 0.94] were less likely to experience asthma exacerbation. Conclusion Despite their limitations, the PDC and the MPR still remain the most common measures for assessing adherence in asthma pharmacy claim databases. The evidence synthesis showed that an adherence threshold of at least 0.75 is optimal for classifying adherent and non-adherent asthma patients.

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Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

van Boven,

Lavorini,

Agh

et al. 2024

The Journal of Allergy and Clinical Immunology: In Practice

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Multifaceted interventions improve medication adherence and reduce acute hospitalization rates in medicaid patients prescribed asthma controllers

Abstract: Managed care-led interventions can effectively improve medication adherence and reduce acute hospitalizations in high-risk Medicaid populations.

Cited by 6 publications

References 20 publications

<p>Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study</p>

<p>Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study</p>

Measuring Medication Adherence in a Population-Based Asthma Administrative Pharmacy Database: A Systematic Review and Meta-Analysis

Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

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