Controller Medications Underused in Asthma Inpatients

Laurie Barclay, MD

August 08, 2011

August 8, 2011 — Controller medications and follow-up are underused in young patients hospitalized for asthma, according to the results of a retrospective analysis of South Carolina Medicaid data from 2007-2009, reported online July 28 in Hospital Pediatrics.

"Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up," write Annie Lintzenich, MD, from the Division of General Pediatrics at the Medical University of South Carolina in Charleston, and colleagues. "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."

Study participants included were 2 to 18 years old with 1 or more asthma-related hospitalizations. Outcome variables were prescription of controller medication, defined as any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after hospital admission, and follow-up appointment, defined as any outpatient visit for asthma during the same period.

Potential predictive variables were age, sex, race, and rural location. The χ2 test was used for bivariate analyses, and factors predicting use of controller medications and follow-up were identified with logistic regression models.

The study sample consisted of 505 patients (60% male, 79% minority race/ethnicity, and 58% urban). Only half of patients received controller medications (52%) or attended follow-up appointments (49%), and less than one third (32%) received both controller medications and follow-up.

Patients who were not of minority race or ethnicity were more likely to receive controller medications, according to multivariable analyses (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1 - 2.6).

"Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and follow-up attendance," the study authors write. "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."

Limitations of this study include retrospective design, use of International Classification of Diseases, Ninth Revision, codes to identify participants, lack of generalizability to other states, and inability to determine if the prescriptions for controller medications were written by hospitalists or primary care providers. In addition, reliance on pharmacy claims data prevented determination of whether the disparity in the dispensing of controller medications occurred because of differences in rates of prescribing or in rates of prescription filling.

"Pediatric hospital care providers are poised to contribute to the improved delivery of preventive care to hospitalized asthma patients," the study authors conclude. "In accordance with the [Global Initiative for Asthma (GINA)] guidelines, we suggest uniform and more aggressive prescribing of controller medications at hospital discharge and, perhaps in the future, dispensing controller medications before discharge to eliminate barriers related to prescription filling. In addition, a focus on addressing health beliefs pertinent to chronic asthma care in a culturally competent manner will be vital to address the racial/ethnic disparities in preventive care delivery for hospitalized asthma patients."

A National Research Service Award supported this study. The study authors have disclosed no relevant financial relationships.

Hosp Pediatr. Published online July 28, 2011.

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