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Provision of pneumococcal prophylaxis for publicly insured children with sickle cell disease
Colin M Sox1, William O Cooper, Thomas D Koepsell
1Department of Pediatrics, University of Washington, Seattle 98195-7183, USA. colinsox@u.washington.edu
Insights
Children with sickle cell disease (SCD) often receive insufficient antibiotic prophylaxis, increasing infection risks. Preventive care visits correlate with better medication delivery for these vulnerable children.
Area of Science:
- Pediatric infectious diseases
- Hematology
- Public health
Background:
- Children younger than 5 years with sickle cell disease (SCD) require daily prophylactic antibiotics to prevent pneumococcal infections.
- The actual amount of prophylactic medication dispensed to these children remains unclear.
Purpose of the Study:
- To quantify the prophylactic antibiotic dispensing for young children with SCD.
- To identify factors influencing the delivery of these essential medications.
Main Methods:
- Retrospective longitudinal study using Medicaid administrative claims from Tennessee and Washington State (1995-1999).
- Included 261 children under 4 years with SCD, continuously enrolled in Medicaid for one year.
- Measured days covered by prescription fills for specific antibiotics over a 365-day period.
Main Results:
- Patients received a mean of 148.4 days of prophylactic medication annually, with wide variation (10.3% received none, 21.5% received >270 days).
- A mean of 12.7 prescriptions were filled per patient yearly, with a median duration of 10 days.
- Each preventive visit was linked to 12.0 additional days of antibiotics, and each ED visit to 10.0 additional days.
Conclusions:
- Publicly insured children with SCD may have inadequate antibiotic prophylaxis, heightening risks of pneumococcal infection morbidity and mortality.
- Increased outpatient preventive care visits are associated with improved antibiotic prophylaxis provision in children with SCD.
Context:
It is recommended that children younger than 5 years with sickle cell disease (SCD) take daily prophylactic antibiotics to prevent pneumococcal infections; however, how much prophylactic medication they actually are dispensed is unclear.
Objectives:
To measure the amount of prophylactic antibiotics dispensed to young children with SCD and to investigate factors associated with increased delivery of medication.
Design, Setting, And Patients:
Retrospective longitudinal study conducted January 1995 through December 1999 using Tennessee and Washington State Medicaid administrative claims and encounter data. Children (N = 261) who had 1 inpatient or 2 outpatient claims or encounters listing an International Classification of Diseases, Ninth Revision, Clinical Modification code for SCD, were younger than 4 years at study entry (mean age, 1.4 years), and were continuously enrolled in Medicaid for a 1-year period.
Main Outcome Measure:
Number of days during a 365-day period covered by prescription fills for a penicillin or macrolide antibiotic, or for trimethoprim-sulfamethoxazole.
Results:
In a 365-day period, patients were dispensed a mean of 148.4 (SD, 121.3; median, 114; interquartile range [IQR], 39-247) days of prophylactic medication. The total amount of medication dispensed varied widely: 10.3% of patients received none and 21.5% received more than 270 days of medication. In a 365-day period, a mean of 12.7 (SD, 10.5; range, 0-40) prophylactic prescriptions were filled per patient. The median prescription duration was 10 days. In a multivariate linear regression model adjusting for state, sex, age at study entry, inclusion year, residence in urban community, outpatient inclusion encounter, required prescription co-payment, and number of outpatient visits for nonpreventive care, each preventive visit was associated with 12.0 (95% confidence interval [CI], 2.3-21.7) additional days of prophylactic antibiotics, and each emergency department visit was associated with 10.0 (95% CI, 1.2-18.8) additional days.
Conclusions:
Publicly insured children with SCD may receive inadequate antibiotic prophylaxis against pneumococcal infections, placing them at increased risk of morbidity and mortality; however, increased numbers of outpatient visits for preventive care are associated with improved provision of prophylactic antibiotics.
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