Ratio of Inhaled Corticosteroid to Bronchodilator Treatment and Asthma Hospitalisation

Frischer, Martin; Heatlie, Heath; Chapman, Stephen; Bashford, James; Norwood, Jeff; Millson, David

doi:10.1185/0300799009117002

Cited by 6 publications

(7 citation statements)

References 11 publications

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“…It has been shown that the P:R ratio can be applied as a surrogate measure to assess the quality of prescribing for asthma, and is an important factor related to asthma morbidity (17, 18). An increased P:R ratio has been associated with improved asthma symptoms (18), reduced need for rescue courses of oral prednisolone (17), and reduced emergency department visits (19), hospital admission (20) and urgent GP visits (21).…”

Section: Discussionmentioning

confidence: 99%

“…There have been other studies examining asthma management that have used the number of canisters (27, 28) or defined daily doses (DDDs) (17, 20) as a measure of ICS use. The limitation of using the number of canisters is that it does not account for the number of doses per canister or differing drug potencies, whereas a limitation of using DDDs is the poor representation of the widely accepted dose equivalence.…”

Section: Discussionmentioning

confidence: 99%

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The sustainability of a community pharmacy intervention to improve the quality use of asthma medication

Bereznicki¹,

Peterson²,

Jackson³

et al. 2010

Journal of Clinical Pharmacy and Therapeutics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The sustainability of a community pharmacy intervention to improve the quality use of asthma medication

Bereznicki¹,

Peterson²,

Jackson³

et al. 2010

Journal of Clinical Pharmacy and Therapeutics

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“…It has been suggested that the P : R ratio, which can be used as a surrogate measure of the quality of prescribing for asthma, is an important factor in the outcome of asthma care 14 , 16 . An increased P : R ratio has been associated with reductions in asthma symptoms, 16 in rescue courses of oral prednisolone, 14 in hospital admissions 15 and in urgent GP visits 17…”

Section: Discussionmentioning

confidence: 99%

“…There have been other studies examining asthma management that have used the number of canisters 19 , 20 or defined daily doses 14 , 15 as a measure of ICS use. The limitation of using the number of canisters is that it does not account for the number of doses per canister or differing drug potencies.…”

Section: Discussionmentioning

confidence: 99%

Data‐mining of medication records to improve asthma management

Bereznicki

Peterson

Jackson

et al. 2008

Medical Journal of Australia

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Objectives: To use community pharmacy medication records to identify patients whose asthma may not be well managed and then implement and evaluate a multidisciplinary educational intervention to improve asthma management. Design, setting and participants: We used a multisite controlled study design. Forty‐two pharmacies throughout Tasmania ran a software application that “data‐mined” medication records, generating a list of patients who had received three or more canisters of inhaled short‐acting β2‐agonists in the preceding 6 months. The patients identified were allocated to an intervention or control group. Pre‐intervention data were collected for the period May to November 2006 and post‐intervention data for the period December 2006 to May 2007. Intervention: Intervention patients were contacted by the community pharmacist via mail, and were sent educational material and a letter encouraging them to see their general practitioner for an asthma management review. Pharmacists were blinded to the control patients’ identities until the end of the post‐intervention period. Main outcome measure: Dispensing ratio of preventer medication (inhaled corticosteroids [ICSs]) to reliever medication (inhaled short‐acting β2‐agonists). Results: Thirty‐five pharmacies completed the study, providing 702 intervention and 849 control patients. The intervention resulted in a threefold increase in the preventer‐to‐reliever ratio in the intervention group compared with the control group (P < 0.01) and a higher proportion of patients in the intervention group using ICS therapy than in the control group (P < 0.01). Conclusions: Community pharmacy medication records can be effectively used to identify patients with suboptimal asthma management, who can then be referred to their GP for review. The intervention should be trialled on a national scale to determine the effects on clinical, social, emotional and economic outcomes for people in the Australian community, with a longer follow‐up to determine sustainability of the improvements noted.

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“…The concept of RATIO has been used in other studies-mostly with administrative databases with variable results. Some have found the higher the ratio, the more favourable the outcomes such as fewer hospital contacts, [11][12][13] but one did not show a decreased hospital admission rate. 14 The problem with using RATIO with aggregate data is that relationships may be found that may not occur at the individual level-such as linking prescription data with hospital admission data for asthma may select for more unstable asthmatics rather than the morbidity of all asthmatics.…”

Section: Quantitative Researchmentioning

confidence: 99%

Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme

Pisarik

2010

J Prim Health Care

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INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit

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Ratio of Inhaled Corticosteroid to Bronchodilator Treatment and Asthma Hospitalisation

Cited by 6 publications

References 11 publications

The sustainability of a community pharmacy intervention to improve the quality use of asthma medication

The sustainability of a community pharmacy intervention to improve the quality use of asthma medication

Data‐mining of medication records to improve asthma management

Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme

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