Under-Utilization of Controller Medications and Poor Follow-Up Rates Among Hospitalized Asthma Patients

Abstract

OBJECTIVE: Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. METHODS: South Carolina Medicaid data from 2007-2009 were analyzed.Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identifi ed factors that predict controller medications and follow-up. RESULTS:Five hundred fi ve patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confi dence interval, 1.1-2.6). CONCLUSIONS:Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and followup attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations. IntroductionAsthma is the most prevalent chronic condition affecting children.1,2 The prevalence of asthma continues to increase. 1,3 In addition, morbidity and mortality associated with asthma continues to increase, including the number of hospitalizations, missed school days, and missed parental work days. 1,4 Asthma is one of the most common reasons for hospital admission among children.1,5 Appropriate use of controller medications can reduce asthma exacerbations, acute care visits for asthma, and hospitalizations. 5,7 Acknowledging the high rates of acute care visits for asthma, the Institute of Medicine has identifi ed asthma as an ambulatory care-sensitive condition. AN OFFICIAL JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRICSDespite this, current evidence suggests that pediatric asthma patients underutilize preventive care in the ambulatory setting, including controller medications. [9][10][11][12] Asthma patients who are admitted to the hospital for acute exacerbations are at higher risk for future exacerbations 13,14 ; therefore, it is paramount that these patie...

Inhaled Corticosteroid Claims and Outpatient Visits After Hospitalization for Asthma Among Commercially Insured Children

“…6–8 The transition from hospital to home is a particularly vulnerable time for children, including those with asthma. 7, 9–12 Inpatient physicians must determine the appropriate home medication regimen and communicate this effectively to both the family and the primary care physician. One strategy to minimize risk and improve continuity of care during this high risk time is to recommend outpatient follow-up at the time of hospital discharge.…”

The Pharmacy-Level Asthma Medication Ratio and Population Health

“…9,10, 13 Lintzenich et al found that just 52% of children aged 2 to 18 years were prescribed a controller medication after discharge from the hospital-patients who would qualify for and benefit from such medications. 7 Given that many of these same patients may not follow up with a primary care physician, 7 alternative opportunities (and locations) for care delivery should be explored.…”

“…[4][5][6] Disparities are perpetuated by chronic underutilization of medications that can prevent asthma symptoms. [7][8][9][10][11] Underutilization results from underprescribing by providers, underavailability of medications at pharmacies, and nonadherence by patients. [12][13][14][15] Excess morbidity resulting from underuse of proven, evidence-based asthma controller medications puts undue strain on patients, communities, and the health care system.…”

The Pharmacy-Level Asthma Medication Ratio and Population Health

“…9,10,13 Lintzenich et al found that just 52% of children aged 2 to 18 years were prescribed a controller medication after discharge from the hospital-patients who would qualify for and benefit from such medications. 7 Given that many of these same patients may not follow up with a primary care physician, 7 alternative opportunities (and locations) for care delivery should be explored.…”

“…[4][5][6] Disparities are perpetuated by chronic underutilization of medications that can prevent asthma symptoms. [7][8][9][10][11] Underutilization results from underprescribing by providers, underavailability of medications at pharmacies, and nonadherence by patients. [12][13][14][15] Excess morbidity resulting from underuse of proven, evidence-based asthma controller medications puts undue strain on patients, communities, and the health care system.…”